House Committee on Veterans Affairs
Subcommittee on Health
Statement by Ms. Ellen Embrey
Deputy Assistant Secretary of Defense for Force Health
Protection and Readiness
Mr. Chairman, I appreciate the opportunity to appear before the Subcommittee
on Health to report on the Department of Defense's continuing efforts
related to the illnesses and undiagnosed physical symptoms of veterans
of the Gulf War and to provide information on the status of some deployment
health surveillance programs.
First, let me emphasize that the Department of Defense is committed to
providing a world-class health care system for its servicemembers and
their families. This commitment is especially strong today when our soldiers,
sailors, airmen, Marines and Coast Guardsmen are deployed throughout the
world in support of Operation Enduring Freedom and other contingencies.
As America's sons and daughters serve and protect our nation, I recognize
they may encounter unique challenges from operational or environmental
conditions as well as from combat. The Gulf War and subsequent deployments
to Somalia, Bosnia, and Kosovo provided the Department of Defense insights
into the importance of deployment health protection. In response, we have
changed processes, revised procedures, and invested heavily in research
to develop more effective force health protection measures and equipment
for our people; but our work continues. We are assessing and monitoring
current deployments and are committed to provide for all who have health
concerns related to deployments.
The experiences of the Gulf War focused our attention on traditional
and nontraditional challenges to deployment health. Recognizing the seriousness
of these challenges, the Department of Defense sought the assistance of
the Institute of Medicine. In a comprehensive three-year study, titled
"Strategies to Protect the Health of Deployed U.S. Forces,"
the Institute of Medicine validated the challenges facing us and recommended
strategies to better protect the health of the forces in the future. We
have addressed many of these challenges and continue now to build the
broad and integrated systems that will enhance prevention of, accelerate
surveillance for, and increase effectiveness of treatment for deployment-related
illnesses and injuries.
In 2000, the Joint Staff created and established a vision for Force Health
Protection to support Joint Vision 2020. This vision encompasses a set
of health programs that provide an integrated and focused approach to
protect and sustain the Department's most important resources-its servicemembers
and their families. Force Health Protection is built on these pillars-promoting
and sustaining a fit and healthy force, casualty prevention and casualty
care and management. Based on lessons of the Gulf War and subsequent deployments,
this vision takes a life-cycle, long- term approach to protecting the
health of those who serve. However, this vision places its most intense
focus on continuous improvement to the Military Health System's doctrine,
organizations, people, equipment, and technology to support the readiness
and effectiveness of the fighting forces when they deploy. It requires
the monitoring and surveillance of threats and the forces in military
operations, enhancing commanders' and servicemembers' awareness of threats
before they affect the health of the force, and providing essential care
of injured and ill in a theater as well as evacuation for definitive medical
care. These key areas are being rapidly implemented in Afghanistan and
in other deployments today. Health Affairs, the Joint Staff, combatant
commanders, and the military services are indivisible partners within
the Department of Defense in this effort.
The events of the Gulf War also caused the Department to take a hard
look at occupational and environmental health surveillance issues with
a focus on casualty prevention. To that goal, we have designated the U.S.
Army Center for Health Promotion and Preventive Medicine as the Department's
lead agency to provide a comprehensive environmental surveillance program
that:
Identifies risks for diseases and injuries for deployed forces;
Identifies significant environmental and occupational hazards;
Determines the impact of disease or non-battle injury (DNBI) on readiness;
Provides support for commanders, policy makers, and others who can
act to prevent diseases and injury; and
Monitors the effectiveness of prevention strategies and programs.
Another area where we focused attention was medical logistics. Before
the Gulf War, the depot system was the primary means of obtaining medical
supplies. Since then, the Department has observed tremendous improvement
through the implementation of the tri-service Defense Medical Logistics
Standard Support system, which standardizes numerous medical logistics
systems used by the Services' medical departments. This system improves
support to deployed forces and maximizes cost savings by taking advantage
of business practices of the commercial community. As a result, today,
the Department is better prepared to meet the medical materiel requirements
of deployed forces.
Issues and concerns from the Gulf War remain and we intend to continue
our vigorous efforts to address and resolve these issues. We are equally
committed to broaden those efforts to include issues and concerns arising
from current and future deployments. Dr. Winkenwerder takes seriously
his role as the Special Assistant for Gulf War Illnesses, Medical Readiness,
and Military Deployments and has begun to focus on deployment health issues
as they affect the entire Military Health System.
Dr. Winkenwerder, as the Assistant Secretary of Defense for Health Affairs,
has aligned the former staff of the Office of the Special Assistant into
a Deployment Health Support Directorate, which will continue to provide
support and outreach to all those with issues associated with any deployment.
Through my office, that directorate, in cooperation with the Joint Staff
and the military services, will provide critical assessments of deployment
health-related processes and issues. As a result, we can more closely
monitor force deployment health protection issues. Improving the adequacy
of environmental surveillance, completeness of individual medical records,
and implementation of other lessons learned will allow the Military Health
System to be responsive to the health concerns of our servicemembers,
veterans, and their families.
One area in which we continue to advocate the health concerns of servicemembers
and veterans is through our support of medical research. As you may know,
Health Affairs and the Deputy Under Secretary of Defense for Science and
Technology participate on behalf of the Department on the interagency
Research Working Group of the Military Veterans' Health Coordinating Board.
The Research Working Group facilitates coordination and collaboration
of research among the Departments of Defense, Veterans Affairs, and Health
and Human Services. I believe the veterans are best served by following
accepted scientific processes for selection and funding of medical research.
We are committed to investigating the possible causes of illnesses and
treatments for medically unexplained physical symptoms that are affecting
veterans.
We have begun research on the health of military personnel over their
entire careers and beyond. A prospective study of U.S. military forces,
called the Millennium Cohort Study, responds to the need for a longitudinal
study to assess the health impact of major elements of military service,
especially deployments and their associated risks. This study also responds
to recommendations from Congress and the Institute of Medicine to systematically
collect population-based demographic and health data to evaluate the health
of servicemembers throughout their military careers and after leaving
military service. This study will eventually use a cross-sectional sample
of over 140,000 military personnel who will be followed prospectively
every three years over a 21-year period through 2022.
Additionally, in response to veteran concerns and congressional direction,
we have established three centers focused on deployment health issues.
These centers provide research, medical surveillance, and clinical care
services. For example, the Center for Deployment Health Research in San
Diego has established a DoD birth defects registry and monitors reproductive
outcomes among all military families, including those of personnel who
have deployed. All three centers work closely with their VA counterparts-two
centers for the study of war-related illnesses.
The Department also has taken steps to ensure that we deploy fit and
healthy military personnel, that we monitor their health while they are
deployed, and that we assess their health when they return. The Center
for Deployment Health Surveillance at Walter Reed Army Medical Center
in Washington D.C. is our key to tracking and analyzing these deployment
health data. Our policy and practice is to assess potential health threats
in areas of deployment and minimize such threats where feasible. All of
these principles are incorporated in DoD policy letters and directives
and into a policy memorandum of the Joint Staff. The combatant commanders
and their component commands, through the extensive professional efforts
of the military services' medical departments, execute these policies
and directives in the field.
Because we are concerned about the health of veterans, both during their
military service and after they have left active duty, we work closely
with the Department of Veterans Affairs initiating procedures and programs
to facilitate the smooth transition of servicemembers' records to the
VA.
As documented for Gulf War veterans, the majority of ailments found in
deployment participants have been medical conditions seen commonly in
other military, veteran, and civilian outpatient populations. The Deployment
Health Clinical Center at Walter Reed Army Medical Center, in cooperation
with the Department of Veterans Affairs, has developed and tested a patient-oriented,
evidence-based clinical practice guideline to aid primary caregivers in
the assessment of illnesses that occur after deployments. Implementation
of this guideline will begin next month. My expectation is that all beneficiaries
who have been involved with deployments - including families of deployed
servicemembers - will receive health care that is fully responsive to
any special health issues that arise after deployments. I believe this
clinical practice guideline will foster an important partnership between
the individual with the health concern and the caregiver who directs individualized
treatment for better continuity of care.
In addition, the Department continues to work towards fielding medical
information systems to provide complete patient health records electronically,
including all immunizations. Such systems will greatly facilitate the
preservation of individual health records, epidemiological studies of
military health, and transfer of health records to the Department of Veterans
Affairs.
We will continue our close collaboration with the VA to improve medical
service to our veterans. In addition to the clinical practice guideline,
we have instituted common separation medical examinations, which efficiently
serve the needs of veterans, the DoD, and the VA. Another result of the
DoD-VA partnership is "FEDS HEAL." This program establishes
a network that links the provider resources of the VA and the Department
of Health and Human Services Division of Federal Occupational Health to
furnish physical examination, immunization, dental screening, designated
dental treatment, and other specified diagnostic services to units and
individuals in the National Guard and Reserve components. I fully expect
additional successes from our continuing collaboration with the VA.
In conclusion, based on observations during our visits to operational
units of the Department of Defense, we believe the military health services
are totally committed to ensuring the health of our military forces, and
we are committed to doing everything in our power to provide a world-class
health care system for our servicemembers, veterans, and their families.