Gulf War Illnesses
Federal Research Efforts Have Waned, and Research Findings Have Not Been Reassessed Gao ID: GAO-04-815T June 1, 2004More than a decade after the 1991 Persian Gulf War, there is continued interest in the federal response to the health concerns of Gulf War veterans. Gulf War veterans' reports of illnesses and possible exposures to various health hazards have prompted numerous federal research projects on Gulf War illnesses. This research has been funded primarily by the Department of Veterans Affairs (VA), the Department of Defense (DOD), and the Department of Health and Human Services (HHS). In 1993, the President named the Secretary of VA as the responsible party for coordinating research activities undertaken or funded by the executive branch of the federal government on the health consequences of service in the Gulf War. In 2002, a congressionally mandated federal advisory committee--the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RAC)--was established to provide advice on federal Gulf War illnesses research needs and priorities to the Secretary of VA. This statement is based on GAO's report entitled Department of Veterans Affairs: Federal Gulf War Illnesses Research Strategy Needs Reassessment (GAO-04-767). The testimony presents findings about the status of research on Gulf War illnesses and VA's communication and collaboration with RAC.
The federal focus on Gulf War-specific research has waned, but VA has not yet analyzed the latest research findings to identify whether there were gaps in research or to identify promising areas for future research. As of September 2003, about 80 percent of the 240 federally funded medical research projects for Gulf War illnesses had been completed. In recent years, VA and DOD have decreased their expenditures on Gulf War illnesses research and have expanded the scope of their medical research programs to incorporate the long-term health effects of all hazardous deployments. Interagency committees formed by VA to coordinate federal Gulf War illnesses research have evolved to reflect these changing priorities, but over time these entities have been dissolved or have become inactive. In addition, VA has not reassessed the extent to which the collective findings of completed Gulf War illnesses research projects have addressed key research questions or whether the questions remain relevant. The only assessment of progress in answering these research questions was published in 2001, when findings from only about half of all funded Gulf War illnesses research were available. Moreover, it did not identify whether there were gaps in existing Gulf War illnesses research or promising areas for future research. This lack of a comprehensive analysis of research findings leaves VA at greater risk of failing to answer unresolved questions about causes, course of development, and treatments for Gulf War illnesses. RAC's efforts to provide advice and make recommendations to the Secretary of VA on Gulf War illnesses research may have been hampered by VA senior administrators' poor information sharing and limited collaboration on research initiatives and program planning. For example, VA failed to inform RAC about its 2002 major research program announcement that included Gulf War illnesses research. VA and RAC are exploring ways to improve information sharing and collaboration, including VA's hiring of a senior scientist who would both guide VA's Gulf War illnesses research and serve as the agency's liaison for routine updates to the advisory committee. However, most of these changes had not been finalized at the time of GAO's review.
GAO-04-815T, Gulf War Illnesses: Federal Research Efforts Have Waned, and Research Findings Have Not Been Reassessed
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Testimony:
Before the Subcommittee on National Security, Emerging Threats, and
International Relations, Committee on Government Reform, House of
Representatives:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 1 p.m. EST:
Tuesday, June 1, 2004:
GULF WAR IllNESSES:
Federal Research Efforts Have Waned, and Research Findings Have Not
Been Reassessed:
Statement of Janet Heinrich:
Director, Health Care--Public Health Issues:
GAO-04-815T:
GAO Highlights:
Highlights of GAO-04-815T testimony before the Subcommittee on National
Security, Emerging Threats, and International Relations, Committee on
Government Reform, House of Representatives
Why GAO Did This Study:
More than a decade after the 1991 Persian Gulf War, there is continued
interest in the federal response to the health concerns of Gulf War
veterans. Gulf War veterans‘ reports of illnesses and possible
exposures to various health hazards have prompted numerous federal
research projects on Gulf War illnesses. This research has been funded
primarily by the Department of Veterans Affairs (VA), the Department of
Defense (DOD), and the Department of Health and Human Services (HHS).
In 1993, the President named the Secretary of VA as the responsible
party for coordinating research activities undertaken or funded by the
executive branch of the federal government on the health consequences
of service in the Gulf War. In 2002, a congressionally mandated federal
advisory committee”the VA Research Advisory Committee on Gulf War
Veterans‘ Illnesses (RAC)”was established to provide advice on federal
Gulf War illnesses research needs and priorities to the Secretary of
VA.
This statement is based on GAO‘s report entitled Department of Veterans
Affairs: Federal Gulf War Illnesses Research Strategy Needs
Reassessment (GAO-04-767). The testimony presents findings about the
status of research on Gulf War illnesses and VA‘s communication and
collaboration with RAC.
What GAO Found:
The federal focus on Gulf War-specific research has waned, but VA has
not yet analyzed the latest research findings to identify whether there
were gaps in research or to identify promising areas for future
research. As of September 2003, about 80 percent of the 240 federally
funded medical research projects for Gulf War illnesses had been
completed. In recent years, VA and DOD have decreased their
expenditures on Gulf War illnesses research and have expanded the scope
of their medical research programs to incorporate the long-term health
effects of all hazardous deployments. Interagency committees formed by
VA to coordinate federal Gulf War illnesses research have evolved to
reflect these changing priorities, but over time these entities have
been dissolved or have become inactive. In addition, VA has not
reassessed the extent to which the collective findings of completed
Gulf War illnesses research projects have addressed key research
questions or whether the questions remain relevant. The only assessment
of progress in answering these research questions was published in
2001, when findings from only about half of all funded Gulf War
illnesses research were available. Moreover, it did not identify
whether there were gaps in existing Gulf War illnesses research or
promising areas for future research. This lack of a comprehensive
analysis of research findings leaves VA at greater risk of failing to
answer unresolved questions about causes, course of development, and
treatments for Gulf War illnesses.
RAC‘s efforts to provide advice and make recommendations to the
Secretary of VA on Gulf War illnesses research may have been hampered
by VA senior administrators‘ poor information sharing and limited
collaboration on research initiatives and program planning. For
example, VA failed to inform RAC about its 2002 major research program
announcement that included Gulf War illnesses research. VA and RAC are
exploring ways to improve information sharing and collaboration,
including VA‘s hiring of a senior scientist who would both guide VA‘s
Gulf War illnesses research and serve as the agency‘s liaison for
routine updates to the advisory committee. However, most of these
changes had not been finalized at the time of GAO‘s review.
www.gao.gov/cgi-bin/getrpt?GAO-04-815T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Janet Heinrich at (202)
512-7119.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here today as you consider the current status of the
federal government's research into the health concerns of Gulf War
veterans. In the years following the 1991 Persian Gulf War,
approximately 80,000 veterans have reported various symptoms including
fatigue, muscle and joint pains, headaches, memory loss, skin rash,
diarrhea, and sleep disturbances. Scientists have agreed that many
veterans have unexplained illnesses--commonly referred to as Gulf War
illnesses--that are characterized by one or more symptoms that do not
conform to a standard diagnosis. Gulf War veterans' reports of
illnesses and possible exposures to several known and potential health
hazards have prompted numerous federal research projects on the nature,
extent, and treatment of Gulf War illnesses. Federal Gulf War illnesses
research projects have been funded primarily by the Department of
Veterans Affairs (VA), the Department of Defense (DOD), and the
Department of Health and Human Services (HHS). In 1993, the President
named the Secretary of VA as the responsible party for coordinating
research activities undertaken or funded by the executive branch of the
federal government on the health consequences of service in the Gulf
War. In 2002, a congressionally mandated federal advisory committee--
the VA Research Advisory Committee on Gulf War Veterans' Illnesses
(RAC)--was established to provide advice on federal Gulf War illnesses
research needs and priorities to the Secretary of VA. The committee is
made up of members of the general public, including non-VA researchers
and veterans' advocates.
My remarks will summarize our findings on the status of federal
research on Gulf War illnesses and VA's communication and collaboration
with RAC. My statement is based on our report entitled Department of
Veterans Affairs: Federal Gulf War Illnesses Research Strategy Needs
Reassessment (GAO-04-767), which will be issued today. The report also
includes a description of the status of DOD's investigations on
potential exposures of service members and veterans to health hazards,
such as chemical and biological agents, and efforts that have been made
by VA and DOD to monitor cancer incidence among Gulf War veterans.
Our findings are based on interviews with senior officials within VA
and DOD and senior managers within each agency's relevant research
offices. We analyzed pertinent agency documents, including annual
reports to congressional committees describing research priorities,
ongoing and completed projects, and agency funding. Additionally, we
interviewed RAC officials, attended a RAC meeting, and reviewed RAC
reports and recommendations. We conducted our work from September 2003
through May 2004 in accordance with generally accepted government
auditing standards.
In summary, the federal focus on Gulf War-specific research has waned,
and VA--the agency with lead responsibility for coordination of Gulf
War illnesses issues--has not yet analyzed the latest research findings
to identify whether there were gaps in research or to identify
promising areas for future research. As of September 2003, about 80
percent of the 240 federally funded medical research projects for Gulf
War illnesses had been completed. In recent years, VA and DOD have
decreased their expenditures on research specifically for Gulf War
illnesses and have expanded the scope of their medical research
programs to incorporate the long-term health effects of all hazardous
deployments. Interagency committees formed by VA to coordinate federal
Gulf War illnesses research evolved to reflect these changing
priorities, but over time these entities have been dissolved or have
become inactive. In addition, VA has not reassessed the extent to which
the collective findings of completed Gulf War Illnesses research
projects have addressed key research questions or whether the questions
remain relevant. The only assessment of progress in answering these
research questions was published in 2001, when findings from only about
half of all federally funded Gulf War illnesses research were
available. Moreover, the summary did not identify whether there were
gaps in existing Gulf War illnesses research or promising areas for
future research. The lack of a comprehensive analysis leaves VA at
greater risk of failing to answer unresolved questions about causes,
course of development, and treatments for Gulf War illnesses.
RAC's efforts to provide advice and make recommendations on Gulf War
illnesses research may have been hampered by VA senior administrators'
incomplete or unclear information sharing and limited collaboration on
Gulf War illnesses research initiatives and program planning. For
example, VA failed to inform RAC about its 2002 major research program
announcement that included Gulf War illnesses research. However, VA and
RAC are exploring ways to improve information sharing, including VA's
hiring of a senior scientist who would guide VA's Gulf War illnesses
research and serve as the agency's liaison for routine updates to RAC.
However, most of these changes had not been finalized at the time of
GAO's review.
Background:
Although about 700,000 U.S. military personnel were deployed to the
Gulf War in the early 1990s, casualties were relatively light compared
with those in previous major conflicts. Some veterans began reporting
health problems shortly after the war that they believed might be due
to their participation in the conflict. VA, DOD, HHS, and other federal
agencies initiated research and investigations into these health
concerns and the consequences of possible hazardous exposures.
VA is the coordinator for all federal activities on the health
consequences of service in the Gulf War. These activities include
ensuring that the findings of all federal Gulf War illnesses research
are made available to the public and that federal agencies coordinate
outreach to Gulf War veterans in order to provide information on
potential health risks from service in the Gulf War and corresponding
services or benefits. The Secretary of VA is required to submit an
annual report on the results, status, and priorities of federal
research activities related to the health consequences of military
service in the Gulf War to the Senate and House Veterans' Affairs
Committees. VA has provided these reports to Congress since 1995. In
May 2004, VA issued its annual report for 2002.[Footnote 1] VA has
carried out its coordinating role through the auspices of interagency
committees, which have changed over time in concert with federal
research priorities and needs. Specifically, the mission of these
interagency committees has evolved to include coordination for research
on all hazardous deployments, including but not limited to the Gulf
War. (See fig. 1.):
Figure 1: Evolution of Interagency Committees That Coordinated Federal
Gulf War Illnesses Research from 1993 to 2004:
[See PDF for image]
Note: GAO analysis of VA data, public laws, and presidential
directives.
[A] Federal agencies are VA, DOD, and HHS.
[End of figure]
Federal research efforts for Gulf War illnesses have been guided by
questions established by the interagency Research Working Group (RWG),
which was initially established under the Persian Gulf Veterans
Coordinating Board (PGVCB) to coordinate federal research efforts.
Between 1995 and 1996, the RWG identified 19 major research questions
related to illnesses in Gulf War veterans. In 1996, the group added 2
more questions regarding cancer risk and mortality rates to create a
set of 21 key research questions that have served as an overarching
strategy in guiding federal research for Gulf War illnesses. (See app.
I for the list of key questions.) The 21 research questions cover the
extent of various health problems, exposures among the veteran
population, and the difference in health problems between Gulf War
veterans and control populations. In 1998, the RWG expanded federal
Gulf War illnesses research priorities to include treatment,
longitudinal follow-up of illnesses, disease prevention, and improved
hazard assessment; however, no new research questions were added to the
list of 21 key questions. With regard to veterans' health status, the
research questions cover the prevalence among veterans and control
populations of:
* symptoms,
* symptom complexes,
* illnesses,
* altered immune function or host defense,
* birth defects,
* reproductive problems,
* sexual dysfunction,
* cancer,
* pulmonary symptoms,
* neuropsychological or neurological deficits,
* psychological symptoms or diagnoses, and:
* mortality.
With regard to exposure, the research questions cover:
* Leishmania tropica (a type of parasite),
* petroleum,
* petroleum combustion products,
* specific occupational/environmental hazards (such as vaccines and
depleted uranium),
* chemical agents,
* pyridostigmine bromide (given to troops as a defense against nerve
agents), and:
* psychophysiological stressors (such as exposure to extremes of human
suffering).
In 2002, VA established RAC to provide advice to the Secretary of VA on
proposed research relating to the health consequences of military
service in the Gulf War.[Footnote 2] RAC, which is composed of members
of the general public, including non-VA researchers and veterans'
advocates, was tasked to assist VA in its research planning by
exploring the entire body of Gulf War illnesses research, identifying
gaps in the research, and proposing potential areas of future research.
VA provides an annual budget of about $400,000 for RAC, which provides
salaries for two full-time and one part-time employee and supports
committee operating costs. RAC's employees include a scientific
director and support staff who review published scientific literature
and federal research updates and collect information from scientists
conducting relevant research.[Footnote 3] RAC's staff provide research
summaries for discussion and analysis to the advisory committee through
monthly written reports and at regularly scheduled meetings. RAC holds
public meetings several times a year at which scientists present
published and unpublished findings from Gulf War illnesses research. In
2002, RAC published a report with recommendations to the Secretary of
VA. It expects to publish another report soon.
Federal Research on Gulf War Illnesses Has Decreased, and VA Has Not
Collectively Analyzed Research Findings to Determine Research Needs:
As of September 2003, about 80 percent of the 240 federally funded
research projects on Gulf War illnesses have been completed.
Additionally, funding for Gulf War-specific research has decreased,
federal research priorities have been expanded to incorporate the long-
term health effects of all hazardous deployments, and interagency
coordination of Gulf War illnesses research has diminished. Despite
this shift in effort, VA has not collectively reassessed the research
findings to determine whether the 21 key research questions have been
answered or to identify the most promising directions for future
federal research in this area.
Most Federal Gulf War Illnesses Research Projects Are Complete, and
Funding Is Decreasing as Research Priorities Evolve:
Since 1991, 240 federally funded research projects have been initiated
by VA, DOD, and HHS to address the health concerns of individuals who
served in the Gulf War. As of September 2003, 194 of the 240 federal
Gulf War illnesses research projects (81 percent) had been completed;
another 46 projects (19 percent) were ongoing.[Footnote 4] (See fig.
2.):
Figure 2: Cumulative Number of Ongoing and Completed Federal Gulf War
Illnesses Research Projects by Year:
[See PDF for image]
Note: GAO analysis of VA data.
[A] This total includes ongoing projects from 1991 through 1994.
[End of figure]
From 1994 to 2003, VA, DOD, and HHS collectively spent a total of $247
million on Gulf War illnesses research. DOD has provided the most
funding for Gulf War illnesses research, funding about 74 percent of
all federal Gulf War illnesses research within this time frame. Figure
3 shows the comparative percentage of funding by these agencies for
each fiscal year since 1994.
Figure 3: Funding Share for Gulf War Illnesses Research by Agency and
Fiscal Year:
[See PDF for image]
Note: GAO analysis of VA data. Percentages may not add to 100 percent
because of rounding.
[End of figure]
After fiscal year 2000, overall funding for Gulf War illnesses research
decreased. (See fig. 4.) Fiscal year 2003 research funding was about
$20 million less than funding provided in fiscal year 2000.
Figure 4: Funding for Gulf War Research Projects, Fiscal Years 1994-
2003:
[See PDF for image]
Note: GAO analysis of VA data. Dollars include only direct costs
(actual research activities and materials) for each agency and have not
been adjusted for inflation.
[End of figure]
This overall decrease in federal funding was paralleled by a change in
federal research priorities, which expanded to include all hazardous
deployments and shifted away from a specific focus on Gulf War
illnesses. VA officials said that although Gulf War illnesses research
continues, the agency is expanding the scope of its research to include
the potential long-term health effects in troops who served in
hazardous deployments other than the Gulf War. In October 2002, VA
announced plans to commit up to $20 million for research into Gulf War
illnesses and the health effects of other military deployments. Also in
October 2002, VA issued a program announcement for research on the
long-term health effects in veterans who served in the Gulf War or in
other hazardous deployments, such as Afghanistan and Bosnia/
Kosovo.[Footnote 5] As of April 2004, one new Gulf War illnesses
research project, for $450,000, was funded under this program
announcement.
Although DOD has historically provided the majority of funding for Gulf
War illnesses research, DOD officials stated that their agency
currently has no plans to continue funding new Gulf War illnesses
research projects. Correspondingly, DOD has not funded any new Gulf War
illnesses research in fiscal year 2004, except as reflected in modest
supplements to complete existing projects and a new award pending for
research using funding from a specific appropriation. DOD also did not
include Gulf War illnesses research funding in its budget proposals for
fiscal years 2005 and 2006. DOD officials stated that because the
agency is primarily focused on the needs of the active duty soldier,
its interest in funding Gulf War illnesses research was highest when a
large number of Gulf War veterans remained on active duty after the
war--some of whom might develop unexplained symptoms and syndromes that
could affect their active duty status.[Footnote 6] In addition, since
2000, DOD's focus has shifted from research solely on Gulf War
illnesses to research on medical issues of active duty troops in
current or future military deployments.[Footnote 7] For example, in
2000, VA and DOD collaborated to develop the Millennium Cohort study,
which is a prospective study evaluating the health of both deployed and
nondeployed military personnel throughout their military careers and
after leaving military service. The study began in October 2000 and was
awarded $5.25 million through fiscal year 2002, with another $3 million
in funding estimated for fiscal year 2003.
VA's Coordination of Federal Gulf War Illnesses Research Has Lapsed,
and VA Has Not Determined Whether Key Research Questions Have Been
Answered:
VA's coordination of federal Gulf War illnesses research has gradually
lapsed. Starting in 1993, VA carried out its responsibility for
coordinating all Gulf War health-related activities, including
research, through interagency committees, which evolved over time to
reflect changing needs and priorities. (See fig. 1.) In 2000,
interagency coordination of Gulf War illnesses research was subsumed
under the broader effort of coordination for research on all hazardous
deployments. Consequently, Gulf War illnesses research was no longer a
primary focus. The most recent interagency research subcommittee, which
is under the Deployment Health Working Group (DHWG), has not met since
August 2003, and as of April 2004, no additional meetings had been
planned.
Additionally, VA has not reassessed the extent to which the collective
findings of completed Gulf War Illnesses research projects have
addressed the 21 key research questions developed by the RWG. (See app.
I.) The only assessment of progress in answering these research
questions was published in 2001, when findings from only about half of
all funded Gulf War illnesses research were available. Moreover, the
summary did not identify whether there were gaps in existing Gulf War
illnesses research or promising areas for future research. No
reassessment of these research questions has been undertaken to
determine whether they remain valid, even though about 80 percent of
federally funded Gulf War illnesses research projects now have been
completed. In 2000, we reported that without such an assessment, many
underlying questions about causes, course of development, and
treatments for Gulf War illnesses may remain unanswered.[Footnote 8]
RAC's Efforts to Provide Advice May Be Hindered by VA's Limited
Information Sharing and Collaboration, but Several Changes to Address
These Issues Have Been Proposed:
RAC's efforts to provide advice and make recommendations on Gulf War
illnesses research may have been impeded by VA's limited sharing of
information on research initiatives and program planning as well as
VA's limited collaboration with the committee. However, VA and RAC are
exploring ways to improve information sharing, including VA's hiring of
a senior scientist who would both guide the agency's Gulf War illnesses
research and serve as the agency's liaison to provide routine updates
to RAC. VA and RAC are also proposing changes to improve collaboration,
including possible commitments from VA to seek input from RAC when
developing research program announcements. At the time of our review,
most of these proposed changes were in the planning stages.
RAC Officials Cite VA's Poor Information Sharing and Limited
Collaboration as Impediments in Meeting Its Mission:
According to RAC officials, VA senior administrators' poor information
sharing and limited collaboration with the committee about Gulf War
illnesses research initiatives and program planning may have hindered
RAC's ability to achieve its mission of providing research advice to
the Secretary of VA. RAC is required by its charter to provide advice
and make recommendations to the Secretary of VA on proposed research
studies, research plans, and research strategies relating to the health
consequences of service during the Gulf War. (See app. II for RAC's
charter.) RAC's chairman and scientific director said that the
recommendations and reports that the advisory committee provides to the
Secretary of VA are based on its review of research projects and
published and unpublished research findings related to Gulf War
illnesses.
Although RAC and VA established official channels of communication, VA
did not always provide RAC with important information related to Gulf
War illnesses research initiatives and program planning. In 2002, VA
designated a liaison to work with RAC's liaison in order to facilitate
the transfer of information to the advisory committee about the
agency's Gulf War illnesses research strategies and studies. However,
RAC officials stated that most communication occurred at their request;
that is, the VA liaison and other VA staff were generally responsive to
requests but did not establish mechanisms to ensure that essential
information about research program announcements or initiatives was
automatically provided to the advisory committee. For example,
according to RAC officials, VA's liaison did not inform RAC that VA's
Office of Research and Development was preparing a research program
announcement until it was published in October 2002. Consequently, RAC
officials said that they did not have an opportunity to carry out the
committee's responsibility of providing advice and making
recommendations regarding research strategies and plans. In another
instance, RAC officials stated that VA did not notify advisory
committee members that the Longitudinal Health Study of Gulf War Era
Veterans--a study designed to address possible long-term health
consequences of service in the Gulf War--had been developed and that
the study's survey was about to be sent to study participants. RAC
officials expressed concern that VA did not inform the advisory
committee about the survey even after the plans for it were made
available for public comment.
Information sharing about these types of issues is common practice
among advisory committees of the National Institutes of Health (NIH),
which has more federal advisory committees than any other executive
branch agency.[Footnote 9] For example, a senior official within NIH's
Office of Federal Advisory Committee Policy said that it is standard
practice for NIH advisory committees to participate closely in the
development of research program announcements. In addition, NIH's
advisory committee members are routinely asked to make recommendations
regarding both research concepts and priorities for research projects,
and are kept up-to-date about the course of ongoing research projects.
VA and RAC Are Exploring Methods to Improve Information Sharing and
Collaboration:
In recognition of RAC's concerns, VA is proposing several actions to
improve information sharing, including VA's hiring of a senior
scientist to lead its Gulf War illnesses research and improving formal
channels of communication. In addition, VA and RAC are exploring
methods to improve collaboration. These would include possible
commitments from VA to seek input from RAC when developing research
program announcements and to include RAC members in a portion of the
selection process for funding Gulf War illnesses research projects. As
of April 2004, most of the proposed changes were in the planning
stages.
Since the February 2004 RAC meeting, VA and RAC officials said they
have had multiple meetings and phone conversations and have
corresponded via e-mail in an attempt to improve communication and
collaboration. VA officials said they have already instituted efforts
to hire a senior scientist to guide the agency's Gulf War illnesses
research efforts and to act as liaison to RAC. According to VA
officials, this official will be required to formally contact RAC
officials weekly, with informal communications on an as-needed basis.
In addition, this official will be responsible for providing periodic
information on the latest publications or projects related to Gulf War
illnesses research.
In an effort to facilitate collaboration with RAC, VA has proposed
involving RAC members in developing VA program announcements designed
to solicit research proposals, both specifically regarding Gulf War
illnesses and in related areas of interest, such as general research
into unexplained illnesses. RAC officials stated that throughout March
and April 2004, they worked with VA officials to jointly develop a new
research program announcement for Gulf War illnesses. In addition, VA
has proposed that RAC will be able to recommend scientists for
inclusion in the scientific merit review panels. VA also plans to
involve RAC in review of a project's relevancy to Gulf War illnesses
research goals and priorities after the research projects undergo
scientific merit review. This could facilitate RAC's ability to provide
recommendations to VA regarding the projects that the advisory
committee has judged are relevant to the Gulf War illnesses research
plan.
Concluding Observations:
Although about 80 percent of federally funded Gulf War illnesses
research projects have been completed, little effort has been made to
assess progress in answering the 21 key research questions or to
identify the direction of future research in this area. Additionally,
in light of decreasing federal funds and expanding federal research
priorities, research specific to Gulf War illnesses is waning. Without
a comprehensive reassessment of Gulf War illnesses research, underlying
questions about the unexplained illnesses suffered by Gulf War veterans
may remain unanswered.
Since RAC's establishment in January 2002, its efforts to provide the
Secretary of VA with advice and recommendations may have been hampered
by VA's incomplete disclosure of Gulf War illnesses research
activities. By limiting information sharing with RAC, VA will not fully
realize the assistance that the scientists and veterans' advocates who
serve on the RAC could provide in developing effective policies and
guidance for Gulf War illnesses research. VA and RAC are exploring new
approaches to improve information sharing and collaboration. If these
approaches are implemented, RAC's ability to play a pivotal role in
helping VA reassess the future direction of Gulf War illnesses research
may be enhanced. However, at the time of our review most of these
changes had not been formalized.
Mr. Chairman, this completes my prepared statement. I would be happy to
respond to any questions you or other Members of the Subcommittee may
have at this time.
Contact and Staff Acknowledgments:
For further information about this testimony, please contact me at
(202) 512-7119 or Bonnie Anderson at (404) 679-1900. Karen Doran, John
Oh, Danielle Organek, and Roseanne Price also made key contributions to
this testimony.
[End of section]
Appendix I: Key Gulf War Illnesses Research Questions:
Between 1995 and 1996, the Research Working Group (RWG) of the
interagency Persian Gulf Veterans' Coordinating Board identified 19
major research questions related to illnesses in Gulf War Veterans. The
RWG later added 2 more questions to create a set of 21 key research
questions that serve as a guide for federal research regarding Gulf War
illnesses. (See table 1.):
Table 1: 21 Key Gulf War Illnesses Research Questions:
Research Question Number: 1;
Key Research Questions: What is the prevalence of symptoms/illnesses in
the Persian Gulf veterans population? How does this prevalence compare
to that in an appropriate control group?
Research Question Number: 2;
Key Research Questions: What was the overall exposure of troops to
Leishmania tropica?
Research Question Number: 3;
Key Research Questions: What were the exposure concentrations to
various petroleum products, and their combustion products, in typical
usage during the Persian Gulf conflict?
Research Question Number: 4;
Key Research Questions: What was the extent of exposure to specific
occupational/environmental hazards known to be common in the Persian
Gulf veteran's experience? Was this exposure different from that of an
appropriate control group?
Research Question Number: 5;
Key Research Questions: What were the potential exposures of troops to
organophosphate nerve agent and/or sulfur mustard as a result of allied
bombing at Muhammadiyat and Al Muthannna, or the demolition of a
weapons bunker at Khamisiyah?
Research Question Number: 6;
Key Research Questions: What was the extent of exposure to chemical
agent, other than at Khamisiyah, Iraq, in the Persian Gulf as a
function of space and time?
Research Question Number: 7;
Key Research Questions: What was the prevalence of pyridostigmine
bromide use among Persian Gulf troops?[A].
Research Question Number: 8;
Key Research Questions: What was the prevalence of various
psychophysiological stressors among Persian Gulf veterans? Is the
prevalence different from that of an appropriate comparison
population?
Research Question Number: 9;
Key Research Questions: Are Persian Gulf veterans more likely than an
appropriate comparison group to experience nonspecific symptoms and
symptom complexes?
Research Question Number: 10;
Key Research Questions: Do Persian Gulf veterans have a greater
prevalence of altered immune function or host defense when compared
with an appropriate control group?
Research Question Number: 11;
Key Research Questions: Is there a greater prevalence of birth defects
in the offspring of Persian Gulf veterans than in an appropriate
control population?
Research Question Number: 12;
Key Research Questions: Have Persian Gulf veterans experienced lower
reproductive success than an appropriate control population?
Research Question Number: 13;
Key Research Questions: Is the prevalence of sexual dysfunction greater
among Persian Gulf veterans than among an appropriate comparison
population?
Research Question Number: 14;
Key Research Questions: Do Persian Gulf veterans report more pulmonary
symptoms or diagnoses than persons in appropriate control populations?
Research Question Number: 15;
Key Research Questions: Do Persian Gulf veterans have a smaller
baseline lung function in comparison to an appropriate control group?
Do Persian Gulf veterans have a greater degree of nonspecific airway
reactivity in comparison to an appropriate control group?
Research Question Number: 16;
Key Research Questions: Is there a greater prevalence of organic
neuropsychological and neurological deficits in Persian Gulf veterans
compared to appropriate control populations?
Research Question Number: 17;
Key Research Questions: Can short-term, low-level exposures to
pyridostigmine bromide, the insect repellent DEET, and the insecticide
permethrin, alone or in combination, cause short-term and/or long-term
neurological effects?
Research Question Number: 18;
Key Research Questions: Do Persian Gulf veterans have a significantly
higher prevalence of psychological symptoms and/or diagnoses than do
members of an appropriate control group?
Research Question Number: 19;
Key Research Questions: What is the prevalence of leishmaniasis and
other infectious diseases in the Persian Gulf veteran population?
Research Question Number: 20;
Key Research Questions: Do Persian Gulf veterans have a greater risk of
developing cancers of any type when compared with an appropriate
control population?
Research Question Number: 21;
Key Research Questions: Are Persian Gulf veterans experiencing a
mortality rate that is greater than that of an appropriate control
population? Are specific causes of death related to service in the
Persian Gulf?
Source: VA.
[A] Pyridostigmine bromide (PB) is a drug that was supplied to troops
for use as a pretreatment for potential exposure to nerve agents.
[End of table]
[End of section]
Appendix II: Charter For the VA Research Advisory Committee On Gulf War
Veterans' Illnesses (RAC):
DEPARTMENT OF VETERANS AFFAIRS
CHARTER OF THE RESEARCH ADVISORY COMMITTEE ON GULF WAR VETERANS'
ILLNESSES:
A. OFFICIAL DESIGNATION: Research Advisory Committee on Gulf War
Veterans' Illnesses (RACGWVI).
B. OBJECTIVES AND SCOPE OF ACTIVITY: The Department of Veterans Affairs
(VA) Research Advisory Committee on Gulf War Veterans' Illnesses shall
provide advice and make recommendations to the Secretary of Veterans
Affairs on proposed research studies, research plans, and research
strategies relating to the health consequences of military service in
the Southwest Asia theater of operations during the Persian Gulf War.
The Committee shall not conduct scientific research.
The guiding principle for the work of the Committee shall be the
premise that the fundamental goal of Gulf War-related government
research, either basic or applied, is to ultimately improve the health
of ill Gulf War veterans, and that the choice and success of research
efforts shall be judged accordingly. The Committee shall assess the
overall effectiveness of government research to answer central
questions on the nature, causes, and treatments of Gulf War-associated
illnesses.
C. PERIOD OF TIME NECESSARY FOR THE COMMITTEE TO CARRY OUT ITS
PURPOSE(S): The Committee was established in compliance with statutory
instructions contained in Section 104 of Public Law 105-368. It has no
termination date.
D. OFFICIAL TO WHOM THE COMMITTEE REPORTS: The Committee shall report
to the Secretary of Veterans Affairs.
E. OFFICE RESPONSIBLE FOR PROVIDING THE NECESSARY SUPPORT TO
THE COMMITTEE: The Department of Veterans Affairs will provide support
for the Committee. A VA employee selected by the Secretary of Veterans
Affairs shall be the Designated Federal Officer, under the direction of
the Committee chair. Technical support for the Committee shall be
provided by a staff that reports to the Committee chair, who may
appoint a technical director for the staff to supervise its operation.
Staff members may be VA employees, employees of other government
agencies, or independent agents employed as temporary VA employees.
F. DUTIES FOR WHICH THE COMMITTEE IS RESPONSIBLE: The Committee shall
provide to the Secretary of Veterans Affairs, not later than December 1
of each year, an annual report summarizing its activities for the
preceding year. The Committee is authorized to develop additional
reports and recommendations regarding relevant research. During its
review of such research and in compliance with governing law, the
Committee shall have access to all VA documents and other information
sources it finds relevant to such review. Recommendations contained
within a formal Committee
report shall be submitted to the Secretary and other appropriate
officials, as directed by the Secretary.
The Committee shall be comprised of members of the general public,
including Persian Gulf War veterans, representatives of such veterans,
and members of the medical and scientific communities representing
appropriate disciplines such as, but not limited to, biomedicine,
epidemiology, immunology, environmental health, neurology, and
toxicology. The Secretary of Veterans Affairs may appoint non-U.S.
citizens as Committee members.
Members shall be appointed for two-or three-year terms. The Secretary
of Veterans Affairs may renew the terms of members. The Secretary shall
appoint the chair of the Committee. The term of office for the chair
shall be two years, also renewable by the Secretary.
The Committee may establish subcommittees to carry out specific
projects or assignments. The Committee chair shall notify the Secretary
upon the establishment of any subcommittee, including its function,
members and estimated duration.
The Secretary of Veterans Affairs may establish a panel of experts
representing appropriate medical and scientific disciplines to assist
the Committee in its work. Panelists may be called on by the Secretary
for advice and consultation, and may advise the Committee on research
or conduct other appropriate activities for the Committee, at the
request of the Committee chair. Panelists shall report directly to the
chair or such Committee members designated by the chair, but they shall
not be members of the Committee.
G. ESTIMATED ANNUAL OPERATING COSTS IN DOLLARS AND STAFF-YEARS: The
estimated annual cost for operating the Committee and its support staff
is $400,000 and 4 FTE. All members will receive travel expenses and a
per diem allowance in accordance with the Federal Travel Regulations
for any travel made in connection with their duties as members of the
Committee.
H. ESTIMATED NUMBER AND FREQUENCY OF MEETINGS: Meetings of the Committee
shall occur not less than twice annually at the call of the chair.
Meetings of the subcommittee(s) shall be convened as necessary. A
federal government official shall be present at all meetings.
I. COMMITTEE TERMINATION DATE: None.
J. DATE CHARTER IS FILED:
APPROVED: Signed by Anthony J. Principi
Date: 1/14/2004 Secretary of Veterans Affairs:
[End of section]
FOOTNOTES
[1] See Deployment Health Working Group Research Subcommittee,
Department of Veterans Affairs, Annual Report to Congress: Federally
Sponsored Research on Gulf War Veterans' Illnesses for 2002
(Washington, D.C.: 2004).
[2] VA was required to establish RAC by the Veterans Programs
Enhancement Act of 1998, Pub. L. No. 105-368, § 104, 112 Stat. 3315,
3323 (1998).
[3] RAC's scientific director, a research associate professor, is also
an appointed member of RAC.
[4] Annual reports to congressional committees submitted by VA on
federally sponsored research on Gulf War veterans' illnesses identify
projects as completed when total project funding has concluded.
[5] The October 2002 research program announcement on deployment health
research remains open for researchers to submit proposals.
[6] DOD officials also told us that there are about 100,000 Gulf War
veterans currently on active military duty but these veterans generally
are in good health.
[7] DOD refers to medical research related to current or future
military deployments as its Force Health Protection Research Program.
This program focuses on prevention of illness, reduction of injuries or
the severity of injury, faster evacuation of casualties, and
enhancements to general medical capabilities.
[8] U.S. General Accounting Office, Gulf War Illnesses: Management
Actions Needed to Answer Basic Research Questions, GAO/NSIAD-00-32
(Washington D.C.: Jan. 6, 2000).
[9] NIH is the largest funder of medical research in the United States
and maintains more than 140 chartered advisory committees. NIH has four
types of advisory committees--for the purposes of this report, we refer
to practices among two of these types: program advisory committees and
national advisory councils.
