House Committee on Government Reform
Subcommittee on National Security, Veterans Affairs,
and International Relations
Statement by Dr. William Winkenwerder, Jr.
Assistant Secretary of Defense for Health Affairs /
Special Assistant for Gulf War Illnesses, Medical Readiness,
and Military Deployments
Mr. Chairman, I appreciate the opportunity to appear before the Subcommittee
on National Security, Veterans Affairs, and International Relations to
report on the Department of Defense's continuing efforts related to the
illnesses and undiagnosed physical symptoms of veterans of the Gulf War,
to review the ongoing medical research into the health of veterans of
all deployments, 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 important
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 we are not finished. We are assessing and
monitoring current deployments and are committed to provide for all who
have health concerns related to deployments.
Issues and concerns from the Gulf War remain and I intend to continue
our vigorous efforts to address and resolve these issues. I am equally
committed to broaden those efforts to include issues and concerns arising
from current and future deployments.
I take seriously my role as the Special Assistant for Gulf War Illnesses,
Medical Readiness, and Military Deployments and have begun to focus on
deployment health issues as they affect the entire military health system.
I have aligned the staff of the office of the former Special Assistant
into my Deployment Health Support Directorate, which will continue to
provide support and outreach to all those with issues associated with
any deployment. Through my Deputy Assistant Secretary of Defense for Force
Health Protection and Readiness, the Deployment Health Support Directorate,
in cooperation with the Joint Staff and the military services, will provide
me critical assessments of deployment health related processes and issues.
As a result, I 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.
This 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.
I am committed to investigating the possible causes of illnesses and treatments
for medically unexplained physical symptoms that are affecting veterans.
Numerous studies have documented that Gulf War veterans report physical
symptoms and medical problems at a greater frequency than do their contemporaries
who did not deploy to the Gulf. Although the precise reasons for these
differences are unclear, we must evaluate these observations to better
understand the potential health effects of military deployments.
The Department's research priorities for this fiscal year include:
- Evaluating the long term health effects of low level chemical exposures
and their interaction with the central nervous system and immune function;
- Developing improved and more sensitive biological, neuropsychological,
and chemical methods to detect exposures from specific chemicals in
individual servicemembers;
- Evaluating toxicity of heavy metals used in weapons systems and improved
methods to diagnose persistent infections such as leishmaniasis;
- Evaluating the implementation of comprehensive health monitoring of
servicemembers and their families;
- Understanding environmental and occupational health risks, including
how to convey these risks to servicemembers; and
- Understanding the causes of chronic fatigue conditions, and their
objective diagnosis and treatment. We are also validating suggestive
findings of biochemical changes in the brain that might provide early
indicators of progressive neurodegenerative disease.
In addition, 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.
Further, 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 military personnel
are fit and healthy when they deploy, 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.
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, also 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 which 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. This guideline is the most recent
in the DOD's and the VA's history of collaboration on clinical practice
guidelines for medical problems in our beneficiaries.
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 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, the Department of Defense is committed to ensuring the
health of our military forces, and I am committed to doing everything
in my power to provide a world-class health care system for our servicemembers
and their families.