Washington – Troops heading for the Iraqi theater are not getting health screenings, especially blood sampling, mandated by a law Congress enacted in 1998.
The law, which grew out of concern about unexplained illnesses that followed the 1991 gulf war, required that troops receive mental and medical examinations before and after deployment overseas. The tests are intended to provide clues in case the phenomenon known as gulf war syndrome should recur.
Instead, the Pentagon requires only a brief, one-page questionnaire asking for general health-related information. A top Pentagon health official said blood tests would not be especially useful.
About 300,000 American personnel are now at jumping-off points near Iraq or on their way. Many consider U.S. troops much more likely than in the 1991 war to face biological and chemical weapons.
“The majority of the troops have already deployed … and therefore we’re not going to have a good picture of their health,” said Steve Robinson, a gulf war veteran and executive director of the National Gulf War Resource Center.
“Once again, if soldiers are exposed, we do not have baseline (medical) data required to document their status. You’re looking at gulf war illness 2.”
The Pentagon insists that it has followed the law.
“If the intent was to make sure we had better documentation — yes, we are in compliance,” said Michael Kilpatrick, a physician who is deputy director of deployment health support at the Pentagon.
Veterans affairs activists, health care experts and congressional watchdogs are unconvinced.
The law, signed by then-President Bill Clinton, was enacted in response to a chorus of health complaints from gulf war veterans. Many reported a variety of ailments, including headaches, memory loss, rashes, equilibrium problems and loss of motor skills.
The causes were unknown, despite numerous medical studies. Some veterans pointed to the release of chemical or biological agents when Iraq’s stockpiles were bombed, the military’s hurried vaccinations against those agents, desert diseases and parasites or pollution from burning oil wells.
The syndrome has caused a bitter battle between veterans and the Pentagon, which has refused to recognize it, and the Department of Veterans Affairs, which has had to decide whether claims for medical compensation are valid.
Democratic Sen. John Kerry of Massachusetts, a former veterans affairs activist, called the Pentagon’s program troubling.
“What’s the message we’re sending to our troops around the world today and those prepared to fight in Iraq?” he asked. “The message seems to be, `Do your duty to country, but your country won’t fulfill its duty to you if you’re lucky enough to return home.’ “
Kerry, a candidate for the Democratic presidential nomination in 2004, has asked the General Accounting Office to investigate whether Defense has met its requirements.
In addition, leaders of the Senate Committee of Veterans Affairs have asked for a detailed account of Pentagon efforts to track medical data on battlefield troops.
Last month, Veterans Affairs Secretary Anthony Principi wrote to Defense Secretary Donald Rumsfeld and said the VA wanted to work closely with the Pentagon to collect “health and exposure data” on those deployed in southwest Asia.
“Much of the controversy over the health problems of the veterans who fought in the 1991 war with Iraq could have been avoided had more extensive surveillance data been collected,” Principi wrote.
Mark Brown, a VA toxicologist who has been investigating gulf war illnesses, said Principi’s letter was intended to put the VA “on the public record” about its concerns.
The Pentagon’s approach, he said, “certainly wasn’t adequate in the first gulf war. Have they learned their lesson and done better? Maybe we’ll be pleasantly surprised.”
The law requires the secretary of defense to “establish a system to assess the medical condition of members of the armed forces,” including reserves, deployed outside the United States for combat, peacekeeping missions or humanitarian operations.
Kilpatrick said the Pentagon’s program was “an evolving process” and part of a concept called “Force Health Protection” that was put in place during the Kosovo conflict in 1996.
Some health officials with the Defense Department appear not to have known what Congress required.
Some gulf war medical researchers proposed a study to the Pentagon a year ago that would track some troops in post-Sept. 11 military operations. The proposed study unknowingly mirrored the elements of the law, and a medical official wrote back, “This sound like something we need to investigate further as something we would like to support.”
The project involved studying the Rhode Island National Guard. David Haines, an immunologist affiliated with George Washington University, said he discovered a month ago that the Department of Defense was supposed to be doing the blood sampling that he and his colleagues had proposed to do on a small scale.
“We will do the right thing and step back if DOD is doing great things, but we don’t believe DOD has anything like that in place,” he said.
According to Kilpatrick, a brief questionnaire is basically the military’s response to the congressional mandate because it has other steps already in place.
In the questionnaire troops are asked how they would rate their health, from excellent to poor. They are also asked whether they have any medical or dental problems, whether they have any health concerns, whether they wear glasses and whether they have concerns about possible “exposures or events during this deployment.”
Anyone answering “yes” to certain questions will be referred for further examination, Kilpatrick said.
Rick Weidman of the lobbying group Vietnam Veterans of America, called the questionnaire “absolutely useless from an epidemiological point of view.”
“There’s nothing about susceptibility to skin rashes or any of the derivative diseases that are due to some of these kinds of exposures,” he said, “and there is no psychological exam. Nothing.”
According to Kilpatrick, troops are asked whether they have sought mental health counseling within the past two years, but the military has to rely on personnel being truthful.
“If people say, `My mental status is fine,’ we are not stopping to engage in a three-hour survey to assess people’s mental status,” Kilpatrick said. “If we are preparing to deploy 20,000 troops, it’s physically impossible.”
A key element of the 1998 law is the taking of blood samples to establish a medical baseline and help identify possible subsequent exposures to toxic materials. The absence of such tests on veterans of the 1991 gulf war has handicapped researchers.
Blood is always taken for HIV testing, Kilpatrick said, and those samples are in storage. But fresh samples will be taken only if the serum on file is more than a year old, he said.
He disputed the idea that additional sampling would be helpful because the biological markers of many toxic agents disappear from the bloodstream within hours or days of exposure.
Also, Kilpatrick said, troops are physically evaluated every five years, except for pilots, who are tested more frequently. Medical histories were more valuable to researchers than “hands-on” physical exams, he said.
But gulf war medical researchers said the Pentagon’s plan is a missed opportunity, especially considering the threat of weapons of mass destruction.
“We can run into the same thing all over again,” said Lea Steele, a Kansas Institute of Health epidemiologist who has studied gulf war veterans. “One of the difficulties of the gulf war was we didn’t have any evidence prior to the war. It was hard to link illnesses.
“Now that we’re becoming a second time deeply involved in Iraq…there is no established protocol that would be very valuable. Some people say Saddam Hussein has less to lose now. He may be more likely to use these things.”
David Goldstein (202) 383-6105, firstname.lastname@example.org.