    [House Hearing, 110 Congress]
    [From the U.S. Government Publishing Office]

                  LEGISLATIVE HEARING ON H.R. 1197, H.R. 3008,
             H.R. 3795, H.R. 4274, H.R. 5155, H.R. 5448, H.R. 5454,
                 H.R. 5709, H.R. 5954, H.R. 5985, AND H.R. 6032

    =======================================================================

                                    HEARING

                                   before the

                           SUBCOMMITTEE ON DISABILITY
                        ASSISTANCE AND MEMORIAL AFFAIRS

                                     of the

                         COMMITTEE ON VETERANS' AFFAIRS
                         U.S. HOUSE OF REPRESENTATIVES

                           ONE HUNDRED TENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 JUNE 12, 2008

                                   __________

                               Serial No. 110-92

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

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                         COMMITTEE ON VETERANS' AFFAIRS

                        BOB FILNER, California, Chairman

    CORRINE BROWN, Florida               STEVE BUYER, Indiana, Ranking
    VIC SNYDER, Arkansas                 CLIFF STEARNS, Florida
    MICHAEL H. MICHAUD, Maine            JERRY MORAN, Kansas
    STEPHANIE HERSETH SANDLIN, South     HENRY E. BROWN, Jr., South
    Dakota                               Carolina
    HARRY E. MITCHELL, Arizona           JEFF MILLER, Florida
    JOHN J. HALL, New York               JOHN BOOZMAN, Arkansas
    PHIL HARE, Illinois                  GINNY BROWN-WAITE, Florida
    SHELLEY BERKLEY, Nevada              MICHAEL R. TURNER, Ohio
    JOHN T. SALAZAR, Colorado            BRIAN P. BILBRAY, California
    CIRO D. RODRIGUEZ, Texas             DOUG LAMBORN, Colorado
    JOE DONNELLY, Indiana                GUS M. BILIRAKIS, Florida
    JERRY McNERNEY, California           VERN BUCHANAN, Florida
    ZACHARY T. SPACE, Ohio               STEVE SCALISE, Louisiana
    TIMOTHY J. WALZ, Minnesota
    DONALD J. CAZAYOUX, Jr., Louisiana

                       Malcom A. Shorter, Staff Director

                                     ______

           SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

                        JOHN J. HALL, New York, Chairman

    CIRO D. RODRIGUEZ, Texas             DOUG LAMBORN, Colorado, Ranking
    PHIL HARE, Illinois                  MICHAEL R. TURNER, Ohio
    SHELLEY BERKLEY, Nevada              GUS M. BILIRAKIS, Florida

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
    current publication process and should diminish as the process is
    further refined.

                                C O N T E N T S

                                   __________

                                 June 12, 2008

                                                                       Page
    Legislative Hearing on H.R. 1197, H.R. 3008, H.R. 3795, H.R.
      4274, H.R. 5155, H.R. 5448, H.R. 5454, H.R. 5709, H.R. 5954,
      H.R. 5985, and H.R. 6032.......................................     1

                               OPENING STATEMENTS

    Chairman John J. Hall............................................     4
        Prepared statement of Chairman Hall..........................    50
    Hon. Doug Lamborn, Ranking Republican Member.....................     7
        Prepared statement of Congressman Lamborn....................    50

                                   WITNESSES

    Congressional Research Service, Library of Congress, Sidath
      Viranga Panangala, Analyst in Veterans Policy..................    17
        Prepared statement of Mr. Panangala..........................    70
    U.S. Department of Veterans Affairs, Bradley G. Mayes, Director,
      Compensation and Pension Service, Veterans Benefits
      Administration.................................................    38
        Prepared statement of Mr. Mayes..............................    89

                                     ______

    Alderson, Lieutenant Commander Jack B., USNR (Ret.), Ferndale, CA    26
        Prepared statement of Lieutenant Commander Alderson..........    83
    Allen, Hon. Thomas H., a Representative in Congress from the
      State of Maine.................................................    13
        Prepared statement of Congressman Allen......................    61
    ALS Association, Jeff Faull, McEwersille, PA.....................    27
        Prepared statement of Mr. Faull..............................    85
    American Ex-Prisoners of War, Les Jackson, Executive Director....    22
        Prepared statement of Mr. Jackson............................    74
    American Legion, Steve Smithson, Deputy Director, Veterans
      Affairs and Rehabilitation Commission..........................    23
        Prepared statement of Mr. Smithson...........................    74
    Bilirakis, Hon. Gus M., a Representative in Congress from the
      State of Florida...............................................     9
        Prepared statement of Congressman Bilirakis..................    59
    Filner, Hon. Bob, Chairman, Committee on Veterans' Affairs, and a
      Representative in Congress from the State of California........     5
    Institute of Medicine of the National Academies, Judith A.
      Salerno, M.D., M.S., Executive Officer.........................    16
        Prepared statement of Dr. Salerno............................    67
    Rehberg, Hon. Denny R., a Representative in Congress from the
      State of Montana...............................................     3
        Prepared statement of Congressman Rehberg....................    54
    Space, Hon. Zachary T., a Representative in Congress from the
      State of Ohio..................................................     8
        Prepared statement of Congressman Space......................    56
    Shea-Porter, Hon. Carol, a Representative in Congress from the
      State of New Hampshire.........................................    11
    Thompson, Hon. Michael, a Representative in Congress from the
      State of California............................................     2
        Prepared statement of Congressman Thompson...................    51
    Vietnam Veterans of America, John Rowan, National President......    25
        Prepared statement of Mr. Rowan..............................    78
    Veterans Affairs of Scott County, IA, David Woods, Director......    30
        Prepared statement of Mr. Woods..............................    87
    Wu, Hon. David, a Representative in Congress from the State of
      Oregon.........................................................    12
        Prepared statement of Congressman Wu.........................    60

                           SUBMISSIONS FOR THE RECORD

    Hon. Michael L. Dominguez, Principal Deputy Under Secretary of
      Defense for Personnel and Readiness, U.S. Department of
      Defense, statement.............................................    94
    Braley, Hon. Bruce L., a Representative in Congress from the
      State of Iowa, statement.......................................    95
    Disabled American Veterans, Kerry Baker, Associate National
      Legislative Director, statement................................    97
    Fort McClellan Veterans Stakeholders Group, Susan R. Frasier,
      Albany, NY, statement..........................................   100
    Lachapelle, Commander Norman C., MSC, USN (Ret.), Administrator,
      Bureau of Environmental Health/Emergency Regional Response,
      Memphis and Shelby County Health Department, TN, statement.....   104
    National Association of State Directors of Veterans Affairs, John
      A. Scocos, President, and Secretary, Wisconsin Department of
      Veterans Affairs, statement....................................   106
    National Vietnam and Gulf War Veterans Coalition, Denise Nichols,
      Vice Chairman, letter..........................................   108
    Olsen, John E., ET-2, USN, Billings, MT, statement...............   108
    Paralyzed Veterans of America, statement.........................   111
    U.S. Military Veterans with Parkinson's (USMVP), Alan Oates,
      Edinburg, VA, Member, statement................................   114

                       MATERIAL SUBMITTED FOR THE RECORD

    Background, Followup Memorandum, and Administration Views:
        Figure S-1, entitled, ``Roles of the Participants Involved in
          the Presumptive Disability Decision-Making Process for
          Veterans,'' and Figures S-2, entitled ``Proposed Framework
          for Future Presumptive Disability Decision-Making Process
          for Veterans,'' Excerpted from the Study entitled,
          ``Improving the Presumption Disability Decision-Making
          Process for Veterans,'' 2008, by Committee on Evaluation of
          the Presumptive Disability Decision-Making Process for
          Veterans, Board on Military and Veterans Health, Jonathan
          M. Samet and Catherine C. Bodurow, Editors, Institute of
          Medicine of the National Academies.........................   118
        Sidath Viranga Panangala, Analyst in Veterans Policy,
          Congressional Research Service, to Kimberly Ross, House
          Committee on Veterans' Affairs, Subcommittee on Disability
          Assistance and Memorial Affairs, Memorandum dated October
          21, 2008...................................................   120
        U.S. Department of Veterans Affairs Views on H.R. 5954, a
          bill to amend title 38, United States Code, to provide
          veterans for presumptions of service connection for
          purposes of benefits under laws administered by Secretary
          of Veterans Affairs for diseases associated with service in
          the Armed Forces and exposure to biological, chemical, or
          other toxic agents as part of Project 112, and for other
          purposes...................................................   121
    Post-Hearing Questions and Responses for the Record:
        Hon. John J. Hall, Chairman, Subcommittee on Disability
          Assistance and Memorial Affairs, Committee on Veterans'
          Affairs, to Hon. Michael L. Dominguez, Principle Deputy
          Under Secretary of Defense for Personnel and Readiness,
          U.S. Department of Defense, letter dated June 23, 2008, and
          DoD responses..............................................   123

                  LEGISLATIVE HEARING ON H.R. 1197, H.R. 3008,
             H.R. 3795, H.R. 4274, H.R. 5155, H.R. 5448, H.R. 5454,
                 H.R. 5709, H.R. 5954, H.R. 5985, AND H.R. 6032

                                  ----------

                            THURSDAY, JUNE 12, 2008

                 U.S. House of Representatives,
                        Committee on Veterans' Affairs,
                      Subcommittee on Disability Assistance and
                                              Memorial Affairs,
                                                        Washington, DC.

        The Subcommittee met, pursuant to notice, at 2:10 p.m., in
    Room 340, Cannon House Office Building, Hon. John J. Hall
    [Chairman of the Subcommittee] presiding.
        Present: Representatives Hall, Lamborn, Turner and
    Bilirakis.
        Also present: Representatives Filner, Space and Brown of
    South Carolina.
        Mr. Filner [presiding]. The Subcommittee on Disability
    Assistance and Memorial Affairs of the House Veterans' Affairs
    Committee is called to order. Unfortunately, if you have heard
    the bells, we have three votes. Just for my colleagues, these
    are the last votes of the day, so we will be back in about a
    half hour. I apologize that with so many bills, we have to hold
    you. We apologize, but we will be back right after the votes.
        Mr. Thompson. Mr. Chairman, would you entertain a question?
        Mr. Filner. Yes, sir.
        Mr. Thompson. Would it be possible for Mr. Rehberg and I to
    make our statement before we recess?
        Mr. Filner. Yes, sir. With unanimous consent.
        Mr. Lamborn. Absolutely.
        Mr. Filner. So ordered. Thank you for the intelligent
    suggestion.
        Mr. Thompson. Thank you, Mr. Chairman. Each of us has an
    airplane to catch to get home. So we appreciate it. Thank you.
        Mr. Filner. Mr. Thompson will be recognized to talk on his
    bill, which is part of a whole theme we are considering today,
    and that is justice for veterans who have been lost through the
    cracks.
        Thank you, Mr. Thompson; thank you, Mr. Rehberg; thank you,
    Ms. Shea-Porter, for your commitment to our veterans.

       STATEMENTS OF HON. MICHAEL THOMPSON, A REPRESENTATIVE IN
       CONGRESS FROM THE STATE OF CALIFORNIA; AND HON. DENNY R.
    REHBERG, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MONTANA

                   STATEMENT OF HON. MICHAEL THOMPSON

        Mr. Thompson. Thank you, Mr. Chairman and Members. The bill
    that we have would grant presumption of a service connection
    for veterans who have been exposed to dangerous chemicals or
    biological agents as part of a test called Project 112 and
    Project SHAD (Shipboard Hazard and Defense). These were Cold
    war-era chemical and biological warfare tests that were
    conducted on U.S. military personnel without their knowledge.
    These ran from about 1962 to 1974, and these tests exposed
    about 6,000 servicemembers to dangerous live agents such as VX
    nerve agent, Sarin gas, and E. coli (Escherichia coli).
        And as I said, for the most part these military personnel
    were unaware they were being used in this test. And for nearly
    30 years the Department of Defense denied that these tests ever
    took place.
        I have today with me, and you will hear from him later,
    Jack Alderson, who is a constituent of mine, who brought this
    issue to my attention in 1998. He is a former tugboat
    commander, and he participated in these tests. He was the guy
    in Project SHAD, and he will tell you how Project SHAD veterans
    are routinely rejected by the VA for medical care and for
    disability benefits.
        You are also going to hear from Dr. Salerno from the
    Institute of Medicine (IOM), who will testify that the study
    that they did found no connection between these substances and
    health problems with the SHAD veterans. I just want to be on
    record as stating that that study that she is going to talk
    about is terribly flawed.
        I want to submit for the record, if I could, I think with
    unanimous consent, the letter that Mr. Rehberg and I sent
    regarding the flaws in this study. And I think that is
    important.
        They took 5 years to do this study. They still have work to
    do, and these veterans can't wait any longer.
        I also want to submit for the record a bibliography that
    outlines all the citations. And I have them here, the
    Subcommittee is welcome to them. Every blue tab on this sheet
    indicates a scientific reporting of how these chemicals that
    the IOM studied said didn't have any connection do, in fact,
    have a connection. And I would like--I am willing to do just
    the bibliography, but I will leave the whole package with you.
        And thank you again for your help on this measure. And just
    to reiterate, these veterans did everything they were asked for
    from our country. They were exposed to dangerous chemicals.
    They are sick. They are suffering as a result of this, and they
    need our help. They can't wait another 5 years, they can't wait
    another 40 years. They were literally lied to for 40 years as
    to whether or not this project, this testing, took place and
    the effect it has had on them. And I appreciate this
    Committee's willingness to finally address the problems that
    they are having. Thank you.
        [The prepared statement of Congressman Thompson, and the
    attached letter and bibliography, appear on p. 51.]
        Mr. Filner. Thank you, Mr. Thompson. And your leadership on
    this for so many years is greatly appreciated. I think we are
    finally going to get justice for these veterans.
        Mr. Rehberg, thank you for your participation, with Mr.
    Thompson on this critical legislation.

                   STATEMENT OF HON. DENNY R. REHBERG

        Mr. Rehberg. Thank you, Mr. Chairman and Members of the
    Subcommittee. And I would really and sincerely like to thank
    Mike Thompson, who has been a tireless advocate on this issue.
    It has been my pleasure to work with him to bring these tests
    to light and fight to get Project 112/SHAD veterans the
    benefits they deserve.
        When I was first elected to the House of Representatives in
    2001, I was approached by Billings resident John Olsen. John
    told me a disturbing tale of a government refusing to be
    accountable for its actions, a long line of healthcare
    problems, and a lack of care.
        In the early Cold war era, as Mike had mentioned, the
    Department of Defense and other Federal agencies conducted
    these series of tests. They used VX nerve gas, Sarin nerve gas,
    and E. Coli, and they were tested on unknowing military
    personnel. John is one of those victims. Over the years he has
    battled several health problems, including skin cancer,
    prostate cancer, and an adrenal tumor the size of a fist.
        Even worse, for more than 40 years the existence of these
    tests had been denied by the Department of Defense, despite
    reports from participating veterans like John that they were
    being stricken with unusual diseases. During that time, many of
    these veterans suffered and died while their government looked
    the other way.
        Finally, in 2001 the DoD did acknowledge that the tests
    took place; however, the Veterans Administration still wouldn't
    provide these veterans with health benefits and compensation
    for their diseases. Instead, the VA commissioned the study.
        We have problems with the study, as was mentioned before.
    While working on this issue, I have been alarmed by the
    deficiency of the program for notifying Project SHAD veterans
    of their exposure. Due to pressure from the Congress, initial
    search efforts began in 2000; however, they were and continue
    to be inadequate, bordering on negligence. Since 2003, the
    Department of Defense has stopped actively searching for
    individuals who were potentially exposed to chemical or
    biological substances during Project 112. At the same time, the
    Department of Defense reported it had identified 5,842
    servicemen and women, and estimated another 350 civilians were
    exposed.
        It is a true tragedy that our government, after exposing
    these servicemen and women to a witches' brew of chemicals,
    cannot be bothered to find and notify them of such. As I
    mentioned earlier, the Department of Defense did identify
    around 350 civilians that were potentially exposed; however, to
    date no effort has even been made to notify these civilians.
        This legislation will help set a standard of oversight for
    the Federal Government's treatment of our soldiers. We can't
    sweep the suffering of these veterans under the rug. We can fix
    the problem created 40 years ago, and this legislation will do
    that.
        Again, thank you for allowing me this opportunity. With
    unanimous consent, I would like to have John Olsen's testimony
    submitted for the record, as well as the U.S Government
    Accountability (GAO) Highlights that suggest DoD and VA need to
    improve efforts to identify and notify individuals potentially
    exposed during chemical and biological tests. It is not a
    pretty report. It needs to be in the record. And they need to
    do the right thing.
        Thank you for your support of this legislation.
        [The prepared statement of Congressman Rehberg, and the GAO
    Highlights, appear on p. 54.]
        Mr. Filner. So ordered on the submission of the testimony
    and reports.
        [The prepared statement of Mr. Olsen appears on p. 108, and
    the other reports will be retained in the Committee files.]
        Mr. Wu and Ms. Shea-Porter, we are going to take a 20-
    minute recess to get our three votes in, and then we will be
    back. I am sure you will join us, and we will hear your
    testimony first when we return.
        Mr. Wu. Thank you very much, Mr. Chairman.
        Mr. Filner. Thank you very much, Mr. Thompson, Mr. Rehberg.
    We will provide that justice.
        We are recessed.
        [Recess.]

                 OPENING STATEMENT OF HON. JOHN J. HALL

        Mr. Hall [presiding]. Good afternoon. The Veterans' Affairs
    Disability Assistance and Memorial Affairs Subcommittee
    legislative hearing will now come back to order. I would ask
    everybody to rise for the Pledge of Allegiance.
        [Pledge of Allegiance recited.]
        Thank you for your patience while we were across the street
    voting.
        First of all, I would like to thank all the witnesses for
    coming, and apologize for my missing the earlier part of the
    session when the Chairman of the full Committee, Mr. Filner,
    graciously filled in for me.
        Mr. Lamborn, our Ranking Member, will be back shortly, and
    at that point he will give his statement.
        We will try to move things along as quickly as possible as
    we consider the 11 bills, 2 of which have already been spoken
    on, H.R. 1197, H.R. 3008, H.R. 3795, H.R. 4274, H.R. 5155, H.R.
    5448, H.R. 5454, H.R. 5709, H.R. 5954, H.R. 5985, and H.R.
    6032. I left the titles out to keep it shorter, but we will
    hear them as we approach each bill.
        As a preliminary, it has already been granted, but I ask
    unanimous consent that Mr. Filner, Mr. Brown, and Mr. Space be
    invited to sit at the dais, which they have already done.
    Without objection, they will be allowed to continue.
        I know the many issues addressed in these bills are of
    utmost importance to many of you in attendance today who, like
    me, have constituents or loved ones who are directly impacted
    by the problems they seek to solve.
        Speaking of witnesses, I welcome you all who are here
    today, including my fellow Members of Congress, I must express,
    however, my disappointment that the DoD did not find it
    ``efficient'' to provide a witness to testify, particularly on
    legislation that has clear DoD implications. Moreover, this
    notice came late last week, after testimony was due, and after
    the DoD had originally indicated that it intended to provide a
    witness.
        I hope to avoid this unnecessary wrangling in the future.
    Our veterans should be important enough to every Federal agency
    involved to send someone to testify. The nexus between the DoD
    and VA are undeniable. Invitations to testify should not be
    rebuffed by the DoD when we are attempting to examine issues
    that overlap on jurisdiction and responsibility. I do note for
    the record that yesterday DoD provided a written statement for
    the record. This fact aside, Congress deserves the right to
    question the appropriate DoD personnel in person, not just in
    writing; not to mention that our men and women who have given
    their all in service to our country deserve the right to have
    their elected officials question the executive branch. This is
    how our system of checks and balances must work to ensure our
    democratic way of governing remains intact.
        After our Ranking Member, Mr. Lamborn, returns we will
    recognize him for his opening statement. And right now I would
    like to recognize the Chair of the full Veterans' Affairs
    Committee to speak on a bill of his, Mr. Filner.
        [The prepared statement of Chairman Hall appears on p. 50.]
        Mr. Filner. Thank you, Mr. Chairman. You have a big list of
    bills. Thank you and Mr. Lamborn for taking up all of these
    bills. I think there is a common theme of long-delayed justice
    for veterans in all these, so I thank you for doing this.
        In addition, you talk about how sad it is that the
    Department of Defense did not send a witness. They did send a
    witness to yesterday's full Committee hearing, at which the
    Principal Deputy Under Secretary of Defense for Personnel
    Readiness said, when confronted with the facts that several
    hundred thousand of our Iraqi veterans and deployed troops have
    PTSD--he said, no, they have symptoms of PTSD. And this is a
    quote: Only a few have PTSD. And so that is what you get when
    you get them here. An incredible, display of irresponsibility
    from the executive branch.
        Mr. Hall. Creative diagnosis.

    STATEMENT OF HON. BOB FILNER, CHAIRMAN, COMMITTEE ON VETERANS'
      AFFAIRS, AND A REPRESENTATIVE IN CONGRESS FROM THE STATE OF
                               CALIFORNIA

        Mr. Filner. So even when you get them here, they say really
    strange things.
        I want to thank you for this panel today. I want to talk
    about two bills: H.R. 3795, the ``You Were There, You Get Care
    Act,'' which would help radiation-exposed veterans of the Gulf
    War and subsequent conflicts; and, H.R. 6032, which would grant
    a presumption of service-connection for Parkinson's disease for
    Vietnam veterans.
        I might say, since I see the national president of the
    Vietnam Veterans Association here, we plan, at the full
    Committee level, working with Mr. Hall, to actually take the
    theme of ``You Were There, You Get Care Act'' for all of the
    Agent Orange claims for Vietnam Veterans. I don't care if your
    boots were not on the ground; you were in the blue water off
    the shore, you were in the blue skies above Vietnam, it is way
    past time for us to take care of all of those veterans, and we
    hope we can do that.
        Depleted uranium (DU), which is the subject of the first
    bill, is an incredibly effective weapon, but its residue has a
    half life of 4 billion years, and evidence indicates that it is
    a carcinogen. We know that many health problems can result from
    exposure to depleted uranium, and we know that if veterans have
    been exposed, we have a responsibility to care for them.
        The bill ``You Were There, You Get Care'' would ensure that
    veterans who served in the 1991 Gulf War and subsequent
    conflicts will be rated service-connected disabled for any
    illnesses currently covered by the Radiation Exposure
    Compensation Act, or RECA, passed by this Congress in 1990. The
    bill will provide payments to individuals who contract cancer
    and other serious diseases as a result of their exposure to
    radiation from above-ground tests of nuclear weapons or from
    employment in underground uranium mines, as well as any other
    diseases found by the VA Secretary to result from depleted
    uranium exposure.
        If this bill is enacted, veterans serving in the Gulf War
    1991 or those providing clean-up or servicing of vehicles or
    equipment that had been in the Persian Gulf would be considered
    exposed. If they become ill, this bill would ensure that the
    illnesses would be deemed service-connected, and VA healthcare
    and compensation would be provided.
        Second, approximately 20 million gallons of herbicides were
    used in Vietnam between 1962 and 1971 to remove foliage and
    vegetation that provided cover for enemy forces during the
    Vietnam War. Following their military service in Vietnam, some
    veterans reported a variety of health problems and concerns due
    to exposure to Agent Orange or other herbicides and pesticides.
        My second bill, H.R. 6032 would establish a presumption of
    service-connection for Parkinson's disease due to exposure to
    Agent Orange for Vietnam veterans.
        I was in Minnesota in Mr. Walz's district, last year, and
    the Vietnam veterans group there gave me a list of hundreds and
    hundreds of Vietnam veterans who had gotten Parkinson's in
    their early fifties, way earlier than, the general population
    typically becomes afflicted with this disease. It is clear
    there is some connection here.
        Although the Department of Veterans Affairs has developed a
    comprehensive program to respond to the Agent Orange-related
    medical problems, there is a lengthy list of diseases that are
    service-connected under title 38, section 1116, which is
    updated as evidence examined by the Institute of Medicine (IOM)
    dictates, however, the list does not include Parkinson's
    disease. Recently, the IOM's report indicated that the evidence
    is insufficient to establish an association between Parkinson's
    disease and the herbicides. But recently, two studies presented
    to the Committee from Stanford University and the Iowa
    Agricultural Health Study update of 2007 seem to indicate that
    Vietnam veterans are more than two-and-a-half times more at
    risk for contracting Parkinson's than the general population,
    and connect Agent Orange to an increased likelihood of
    contracting the disease.
        I believe there is an association between the degenerative
    effects of Parkinson's and Agent Orange, and I urge the IOM to
    consider the findings of those studies. At the very least, as
    pointed out by Chairman Hall, we need to examine the disconnect
    between modern medicine and the current provisions under
    section 1110, which only allow service-connection for chronic
    conditions that manifest within 1 year of service. Modern
    science clearly establishes that the symptoms of these many
    degenerative diseases can take decades to onset.
        So, I also look forward to exploring these discrepancies
    and the issue of insecticide exposure during military spray
    operations to control mosquitoes and to stop casualty rates due
    to malaria, but then, have other unintended harmful effects.
        Mr. Chairman, both these bills, H.R. 3795 and H.R. 6032,
    would make a bold statement if enacted: When our men and women
    volunteer for service or are drafted, they can count on their
    government to compensate them and to care for them if their
    service leads to illness.
        I thank the Chair.
        Mr. Hall. Thank you, Mr. Filner. You make a logical and
    forceful argument for these bills.
        Just to explain procedure, I am going to ask our Ranking
    Member, the Honorable Mr. Lamborn, first for his opening
    statement, and then the Members who are on the dais who have
    legislation before us, and then the Members at the witness
    table. So first Mr. Lamborn, you are now recognized.

                 OPENING STATEMENT OF HON. DOUG LAMBORN

        Mr. Lamborn. Thank you, Mr. Chairman, and for yielding. I
    thank you and your staff for scheduling this hearing today.
        This afternoon we are considering several pieces of
    legislation, all of which are of interest and potential value.
    While I do have some policy concerns regarding a number of the
    provisions, I am primarily struck by the mandatory offsets that
    would be necessary to pass many of these bills under PAYGO
    rules.
        Mr. Chairman, as you know from the PAYGO problems with H.R.
    5892, it is always a challenge to find offsets within our
    jurisdiction, and that is something we need to keep in mind as
    we examine these bills today.
        The main policy concern I wish to express is that some of
    the provisions before us are similar to section 101 of H.R.
    5892 in that they would redefine ``combat with the enemy'' as
    it pertains to section 1154 of title 38. Mr. Chairman, my
    concerns with these types of provisions are not new to you or
    other Members of this Subcommittee, and I will not reiterate
    them here except to point out that a loose definition of
    ``combat'' would diminish the immeasurable sacrifice and
    service of those who actually did face combat. While I
    understand and appreciate the effort to address problems
    regarding the VA claims backlog, I believe that they are
    generally the result from procedural problems, and we should
    address the problems accordingly.
        On another note, I look forward to the testimony of the
    representatives from the Institute of Medicine, IOM, who will
    hopefully enlighten the Subcommittee about the process involved
    in establishing a presumption of service connection for certain
    illnesses and disabilities. Experts at VA and IOM have years of
    experience in dealing with these issues, and I think it is
    important for Congress to avail itself of their expertise
    whenever possible.
        Mr. Chairman, I again extend my thanks to you and your
    staff for holding this hearing, and I look forward to hearing
    the testimony of our colleagues and the other witnesses today.
    I yield back.
        [The prepared statement of Congressman Lamborn appears on
    p. 50.]
        Mr. Hall. Thank you, Mr. Lamborn.
        The Chair recognizes Mr. Space for testimony on his
    legislation.

       STATEMENTS OF HON. ZACHARY T. SPACE, A REPRESENTATIVE IN
       CONGRESS FROM THE STATE OF OHIO; HON. GUS M. BILIRAKIS, A
      REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA; HON.
    CAROL SHEA-PORTER, A REPRESENTATIVE IN CONGRESS FROM THE STATE
     OF NEW HAMPSHIRE; HON. DAVID WU, A REPRESENTATIVE IN CONGRESS
         FROM THE STATE OF OREGON; AND HON. THOMAS H. ALLEN, A
           REPRESENTATIVE IN CONGRESS FROM THE STATE OF MAINE

                   STATEMENT OF HON. ZACHARY T. SPACE

        Mr. Space. Thank you, Chairman Hall, and thank you, Ranking
    Member Lamborn, as well as the Members of the Subcommittee, for
    providing me with the opportunity to speak in favor of H.R.
    5709, the ``Veterans Disability Fairness Act.''
        At the end of last year, the Oversight and Investigations
    Subcommittee held a hearing on an Institute for Defense
    Analysis (IDA) report regarding the average disability payments
    received by veterans in each State. The hearing revealed that
    the VA's current data is lacking, and that regional cultures
    may be partly to blame for similarly disabled veterans
    receiving different ratings, and thus different disability
    payments.
        I introduced legislation specifically geared to correct
    these discrepancies. ``The Veterans Disability Fairness Act''
    requires the VA to collect and monitor regional data on
    disability ratings. It requires the VA Secretary to conduct
    reviews and audits of the rating system. It requires the VA to
    submit a report on an annual basis to Congress to track the
    progress of the program. And it requires VA raters to take
    ownership of their ratings by assigning identification codes to
    all adjudications. The performance of specific raters will be
    then evaluated periodically for consistency and accuracy.
        The current short-changing in ratings is not reflective of
    our heroes' service, and there is no reason that a veteran from
    one State should receive less than veterans in other States.
    This legislation is an important step in addressing these
    issues and in providing needed oversight.
        Additionally, H.R. 5709 supplements this Subcommittee's
    work on Chairman Hall's 5892, the ``Veterans Disability
    Benefits Claims Modernization Act.'' Section 106 of that bill
    calls for an annual assessment of the quality assurance program
    that examines data from regional offices (ROs), the accuracy of
    evaluated claims, and creates automated, categorizable data to
    better identify trends. My bill will require accountability by
    enabling the specific identification of potentially problematic
    claims raters who may knowingly manipulate claims.
    Alternatively, this legislation will protect those claims
    raters who are doing their jobs with integrity.
        This bill is incredibly important to the veterans of Ohio.
    Our State was ranked dead last in average disability payments,
    and I cannot stand for this. According to the IDA report, the
    national average disability payment is $8,890. Ohio's average
    is $7,556. New Mexico, which had the highest in the country, is
    on average $12,395 annually. You can see that that is a
    significant discrepancy. And I believe that we must act to
    restore parity to the disability payment system to ensure that
    each veteran receives the full benefit of what he or she was
    promised. Senator Sherrod Brown, also of Ohio, and also a
    Member of the Senate Veterans' Affairs Committee, agrees, and
    he has introduced identical companion legislation in the
    Senate.
        I would like to thank you once again, Chairman Hall, along
    with Members of the Subcommittee for their consideration of
    H.R. 5709, and I am grateful for the opportunity to present
    this important piece of legislation. Thanks.
        [The prepared statement of Congressman Space appears on p.
    56.]
        Mr. Hall. Thank you, Mr. Space. We will give it every
    consideration, and the other panels will, I am sure, have
    comments to make on your bill, as well as the others before us
    today.
        The Chair would now recognize Mr. Bilirakis for 5 minutes
    to testify on his bill.

                   STATEMENT OF HON. GUS M. BILIRAKIS

        Mr. Bilirakis. Thank you so much.
        I would like to start by thanking you, Chairman Hall and
    Ranking Member Lamborn, for including my legislation, H.R.
    1197, on today's hearing agenda. ``The Prisoners of War Benefit
    Act'' is a bill that my father, Congressman Mike Bilirakis,
    first introduced several Congresses ago. He was able to make
    some progress on this legislation before he retired in 2006,
    and I am pleased to be continuing his efforts on this important
    issue in the 110th Congress.
        ``The Prisoners of War Benefits Act'' is intended to
    improve the benefits currently available to former POWs. In
    1981, Congress established several service-connected
    presumptions for certain medical conditions that affect former
    prisoners of war. However, because of a very high level of
    research certainty, 95 percent was required before establishing
    presumptive status, many other medical problems common in POWs
    have been excluded.
        My legislation establishes service-connected presumptions
    for two additional medical conditions, Type 2 diabetes and
    osteoporosis. My staff has worked with the American Ex-
    Prisoners of War to identify these conditions as having strong
    evidence of a relationship between the POW experience and the
    onset of the disease.
        Congress has passed legislation giving the Department of
    Veterans Affairs specific standards for determining whether the
    addition of new presumptive diseases for Vietnam and Gulf War
    vets is warranted. These standards require a positive
    association for the adoption of a presumptive condition.
    However, Congress has not established a process for VA to add
    to the list of former POW presumptive diseases established in
    1981.
        In 2001, the VA Advisory Committee on Former Prisoners of
    War recommended the burden for establishing POW presumptions be
    adjusted to match the standards used for other beneficiary
    groups. Therefore, H.R. 1197 includes a provision to establish
    a process by which the VA could determine future presumptive
    conditions for former POWs when there is a positive association
    between the experience of being a prisoner of war and the
    occurrence of a disease or condition. Under my legislation, the
    VA's Secretary would have to review the recommendations of the
    Advisory Committee on Foreign Prisoners of War and all other
    sound medical and scientific evidence, attachment, and analysis
    available when making this determination.
        Under current law, to be eligible for disability
    compensation for certain conditions presumed to be service-
    connected for former POWs, a veteran must have been held in
    captivity for 30 or more days. At the time when some of the
    original POW presumptions were enacted, short-term prisoners of
    war were unusual. Prisoners of war from more recent conflicts
    have been confined for shorter periods of time. H.R. 1197 would
    remove the 30-day minimum requirement, making all former POWs
    eligible, regardless of how long they were held captive. This
    provision is based on the recommendations of the VA's Advisory
    Committee on Former Prisoners of War, which concluded in 2001
    that this 30-day requirement should be repealed.
        The 108th Congress did enact a partial repeal of the 30-day
    minimum requirements as part of the Veterans Benefits Act of
    2003. Specifically, this law eliminated the requirement that a
    POW be held for 30 days or more to qualify for presumptions of
    service connection for certain disabilities. Although I am
    pleased the Congress took this initial step, I believe that
    more can be done in this regard, and urge my colleagues to
    support H.R. 1197 for this reason.
        Before I close, Mr. Chairman, I would like to mention how
    pleased I am that we have also included H.R. 5454 to today's
    agenda. H.R. 5454, I believe sponsored by Representative Brown,
    which I have cosponsored as well, would establish a presumption
    of service connection for amyotrophic lateral sclerosis (ALS).
    I have heard from some of my constituents whose loved ones
    suffer from this devastating disease. They firmly believe there
    is a link between their loved one's military service and their
    developing ALS.
        In closing, Mr. Chairman, I want to thank you once again
    for including my bill in today's hearing. I hope that you and
    our other Members, our other colleagues on the Subcommittee,
    will support H.R. 1197 and H.R. 5454. I look forward to hearing
    the testimony from today's witnesses.
        Thank you, Mr. Chairman. I appreciate it.
        [The prepared statement of Congressman Bilirakis appears on
    p. 59.]
        Mr. Hall. Mr. Bilirakis, thank you very much for your
    eloquent testimony on behalf of those bills, and we will hear
    testimony from our other panels soon about them.
        But first we will turn to our fellow Members of Congress,
    starting with the Honorable gentlelady from New Hampshire, Ms.
    Carol Shea-Porter, speaking on her bill, H.R. 5155.

                  STATEMENT OF HON. CAROL SHEA-PORTER

        Ms. Shea-Porter. Thank you, Chairman Hall and Ranking
    Member Lamborn, for taking up my bill, H.R. 5155, the ``Combat
    Veterans Debt Elimination Act.'' I am honored to testify before
    you today on behalf of our servicemembers and their families.
    Our soldiers, sailors, airmen, Marines and Coast Guardsmen are
    on the frontline of this generations' struggle against
    terrorism. Our Nation's bravest have answered the call, and in
    towns and villages around the world they are stepping into the
    breach to secure freedom, preserve liberty, and provide relief.
        Tragically, some die in service to our country. Mourning
    our fallen is a difficult and somber reminder that we are in a
    state of persistent conflict. For some families, though, the
    mourning process has been interrupted by an unfortunate
    bureaucratic procedure. Under Title 38 of the U.S. Code, the
    Veterans Administration is required to collect certain debts
    from the estates of servicemembers killed in combat. That
    procedure is wrong, and this bill is its best and only remedy.
    These collections, while not common, are unacceptable, and I
    believe an unintended consequence of a poorly drafted policy.
        This fix is simple, appropriate, and necessary. When our
    servicemembers give their last full measure of devotion, their
    sacrifice should have had no price tag. No debt is larger than
    the one we owe to our Nation's heroes and their families. ``The
    Combat Veterans Debt Elimination Act'' ends the Title 38
    requirement, and today we take the first step toward making
    this right.
        It is my firm belief that the VA and I agree on the intent
    of my legislation, and I expect that they will share those
    views later in this hearing. I am committed to working with the
    VA and with the Committee to ensure it provides a proper remedy
    to this problem without delay. Our interests and our goals here
    are the same. Together we can agree to right this wrong and
    prevent further attempts to collect these small, insignificant
    debts that amount to little more than a rounding error, roughly
    50 cents to every $30 million spent by the Federal Government,
    a mere pittance unless you are one of these family members.
        This country has made a promise to our servicemembers to
    honor their sacrifice and to care for their families while they
    do the work of our Nation. This Committee and this Congress
    have made tremendous steps toward fulfilling these promises.
    Today we continue that forward progress.
        I thank you again for this opportunity to testify before
    the Subcommittee.
        Mr. Hall. Thank you, Ms. Shea-Porter. I appreciate your
    thoughtful presentation about this very worthy piece of
    legislation.
        Next the Chair recognizes the Honorable gentleman from
    Oregon, Mr. Wu.

                       STATEMENT OF HON. DAVID WU

        Mr. Wu. Thank you, Chairman Hall, and Ranking Member
    Lamborn and distinguished Members of the Subcommittee, for the
    opportunity to testify today on behalf of my bill, H.R. 3008,
    the ``Rural Veterans Services Outreach and Training Act.''
        A few years ago I was made aware of a problem that directly
    affects millions of individuals who have defended our country.
    Due to budget cuts in many areas, including my home State of
    Oregon, county veterans service officers are not being funded
    at adequate levels. County veterans service officers provide
    veterans with advice, support, casework service, and other
    services about their VA benefits. There is a singular need for
    these services in our rural communities.
        There are approximately three million veterans living in
    rural areas in the United States. A 2004 report published in
    the American Journal of Public Health shows that veterans in
    rural areas are in poorer health than their urban and suburban
    counterparts. Without access to casework services, these
    veterans go without all the benefits they need, deserve, and
    have earned.
        Some may argue that veterans in rural areas can simply
    drive to the nearest VA regional office, but for many veterans
    and their caregivers, this is impractical. According to the
    National Rural Health Association, the average distance a rural
    veteran must travel to get care is 63 miles. For someone who
    has endured the trauma of a battlefield injury and begun the
    long, arduous process of rehabilitation, this is often simply
    too much to ask.
        Without access to a county veterans service officer,
    veterans must rely solely on customer service representatives
    over the telephone or the Internet in order to access their VA
    services. But anyone who has ever encountered an automated
    phone system knows how frustrating and discouraging this can
    be.
        Veterans who have suffered physical, emotional, or
    psychological injuries should not be forced to navigate the VA
    bureaucracy alone because they do not live near a VA Regional
    Office. Our veterans deserve better, have earned better, and
    will get better under this bill.
        County veterans service officers provide rural communities
    with more than just their expertise. I believe our veterans are
    best served by their fellow community members. Community
    members understand a veteran's needs as they relate to his or
    her community, job, and family and associated circumstances.
    Armed with this attachment, county veterans service officers
    can best advocate for the veterans they serve.
        With this in mind, I introduced the ``Rural Veterans
    Services Outreach and Training Act,'' which seeks to improve
    outreach and assistance to veterans and their families residing
    in rural areas. This bill establishes a competitive grant
    program at the Department of Veterans Affairs to help eligible
    States hire and train county veterans service officers for
    their own rural communities. The Rural Veterans Outreach and
    Training Act targets grant money to the communities that need
    it the most. This legislation requires that grants will be used
    only to supplement non-Federal funding sources, not supplant
    them.
        We have an obligation to ensure that veterans, wherever
    they reside, have access to the services they have earned and
    deserve. Our men and women in uniform give so much in service
    to our country, and I believe we should act accordingly to
    ensure that they have access to local assistance to find the
    help they need. Again, I appreciate the Subcommittee's
    consideration of the Rural Veterans Services Outreach and
    Training Act, and on behalf of a grateful Nation and veterans
    everywhere, I look forward to working with you on this
    important legislation.
        [The prepared statement of Congressman Wu appears on p.
    60.]
        Mr. Hall. Thank you, Mr. Wu.
        As one who represents a district that is in New York, which
    people think of as concrete and skyscrapers, but nonetheless
    has within it Orange County, the black dirt farmers and vast
    stretches of rural landscape stretching toward the Delaware
    River, I can identify, and my veterans can identify, with the
    problems you described.
        We will now turn to Mr. Allen for testimony on his
    legislation.

                     STATEMENT OF HON. THOMAS ALLEN

        Mr. Allen. Thank you, Chairman Hall and Ranking Member
    Lamborn, for holding this hearing. I am grateful for the
    opportunity to testify on my bill, which is H.R. 5448, the
    ``Full Faith in Veterans Act.''
        What we now know as post traumatic stress disorder, or
    PTSD, is not a new phenomenon. The enormous stress of military
    service has long been recognized as the source of disabling
    psychological and emotional illness for many veterans.
    Unfortunately, as I have learned from Maine veterans, proving
    that PTSD is connected to service can be very difficult, and
    denial of service connection leaves these veterans without
    access to VA health benefits or disability compensation.
        The goal of my bill is to ensure that every veteran whose
    PTSD resulted from their service receives treatment and, if
    appropriate, disability compensation. Too often veterans with
    legitimate claims are met with skepticism and red tape. The
    story of one of my constituents highlights this problem.
        Terry Belanger is an Army veteran from Biddeford, Maine.
    During his service from 1969 to 1970, his supply vehicle came
    under enemy fire, he reports, practically every night. Close
    friends were killed in combat, another died in a stabbing. He
    witnessed the torture of Viet Cong officers, and he saw the
    truck ahead of his strike a mine. On one mission a young
    Vietnamese girl suddenly appeared in front of his truck, and
    his vehicle ran over the little girl, apparently killing her.
    Because his convoy was under fire, he could not stop. Terry's
    nightmares about this incident resurfaced years ago, after he
    nearly struck another child who darted in front of his car.
        When he returned from Vietnam, Terry was diagnosed by
    healthcare professionals as suffering from severe PTSD
    resulting from his service in Vietnam. In 1989, he filed a
    claim with the VA for service-connected PTSD. The claim was
    denied due to, and I am going to quote, lack of credible
    attachment of supporting stressors. For years Terry tried to
    get the Army to search for documents that would prove that
    these stressors had occurred. In 1993, the National Personnel
    Records Center basically told Terry to forget it because the
    requested records, quote, would rarely show specific details
    about a unit's activities and movements. They say the agency,
    quote, was unable to perform the extensive research requested
    due to staffing and budget limitations.
        But Terry continued the fight. Finally, in 2005, the
    National Archives found documents that verified that Terry's
    unit was in combat for months, but it took another 3 years for
    the VA to actually approve his claim, which they finally did a
    few weeks ago, 19 years after the claim was first filed.
        Under current law, the veteran bears the burden of
    producing documents to prove the trauma occurred. How is Terry
    Belanger supposed to find the records if the government
    couldn't? In these cases, when no records can be found to
    substantiate the claim, a veteran can also submit two buddy
    statements as evidence their claimed stressor actually
    occurred, but this is no easy task. Many veterans magazines
    contain ads like this one in the April 2008 issue of VFW
    magazine. The ad reads, 173rd Airborne Support Battalion, An
    Khe, Vietnam, 1968-69, seeking anyone who attended Airborne
    Jungle School when one of the instructors was accidentally shot
    by one of the other instructors next to me. Anyone there when
    the school and mess hall were shelled and three people were
    killed. Need substantiation for PTSD claim. William E. Young,
    Jr.
        Veterans should not have to take out classified ads in
    order to have their claims for PTSD approved by the VA. In
    Terry's case, doctors confirmed he had PTSD. His nightmares and
    flashbacks referred to his time in Vietnam. His government
    trusted him when he served his country. Why should we distrust
    him now?
        Under my bill, if a veteran is diagnosed by a certified
    mental health professional as suffering from PTSD relating to
    the veteran's military service, the VA must accept this finding
    as sufficient proof of service connection. The VA can rebut
    this finding of service connection by clear and convincing
    evidence to the contrary. The bill would ensure that the VA
    does a better job at diagnosing and treating this debilitating
    disorder.
        A broad array of veterans groups, including Veterans for
    Common Sense, Swords to Plowshares, and the Maine departments
    of the American Legion, AMVETS, the DAV, and the Veterans of
    Foreign Wars, along with Maine's Bureau of Veterans Services
    support my bill.
        For too long America has neglected our responsibilities to
    the men and women who carry the emotional scars that military
    service sometimes brings. Terry Belanger's wife wrote, ``This
    wonderful man left part of his soul in Vietnam.'' I hope and
    pray that with care and support, Terry and other veterans
    suffering from PTSD will be restored to full and productive
    lives. The Full Faith in Veterans Act can help achieve this
    goal.
        I thank the Subcommittee for the opportunity to testify,
    and would be happy to answer any questions.
        [The prepared statement of Congressman Allen and
    attachments appear on p. 61.]
        Mr. Hall. Thank you, Mr. Allen.
        I sympathize and agree wholeheartedly with the intent and
    the content of your bill. In terms of this presumptive
    stressor, which includes, among other things, PTSD, it may go
    beyond and be more thorough than the Disability Claims
    Modernization Act, H.R. 5892, which we approved out of the
    Subcommittee and the full Committee a few weeks ago.
        The most dramatic case that my staff and I encountered was
    a World War II veteran who came to us 60 years after he had
    been swimming in the Pacific Ocean for the second time, after
    two ships were blown out from under him in World War II. He had
    started trying in his seventies to get some kind of help for
    his emotional problems with the flashbacks and the depression
    and the inability to lead a normal life. Fortunately, he lived
    long enough that we were able to get him a correct diagnosis.
    The VA had diagnosed him as schizophrenic with a preexisting
    condition, meaning when he signed up at age 18, he must have
    been schizophrenic, but they didn't notice it. We got that
    turned into 100 percent PTSD classification just last year.
        So it is true this applies to any war; especially the wars
    in Afghanistan and Iraq, where the enemy is not in front of you
    and your support team behind you. It is sort of everybody is
    everywhere. And as in Vietnam, it is difficult to tell those
    who were working with you, be they translators or logistical
    people, from those, for instance in Iraq, who may turn on you
    with a bomb or a weapon at any time.
        So the stress--whether it is immediate or post traumatic
    stress--is real, and I congratulate you and commend you for
    your legislation.
        I am going to hold off on questions myself. Other Members
    of the Committee, would you like to question this panel? If
    not, we will excuse you. I know you have trains and planes and
    other modes of transportation to catch. I thank you so much for
    your legislation. We will be hearing testimony on it from our
    next panels.
        Congressman Wu, Congressman Allen, thank you very much.
        Mr. Allen. Thank you, Mr. Chairman.
        Mr. Hall. We will ask our second panel, Judith Salerno,
    M.D., M.S., Executive Director of the Institute of Medicine,
    National Academy of Sciences; Sidath Viranga Panangala, Analyst
    of Veterans Policy for the Congressional Research Service;
    Christine Scott, Specialist, Social Policy, Congressional
    Research Services (CRS); and Douglas Weimer, Legislative
    Attorney for the Congressional Research Services, Library of
    Congress.
        Thank you for joining us. Thank you for your patience. As
    usual, your written statement is entered into the record. So
    feel free to shorten it if you want, or embellish upon it if
    that is what you prefer.
        We will begin with Ms. Salerno. You are recognized for 5
    minutes.

     STATEMENTS OF JUDITH A. SALERNO, M.D., MS, EXECUTIVE OFFICER,
      INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES; AND SIDATH
     VIRANGA PANANGALA, ANALYST IN VETERANS POLICY, CONGRESSIONAL
    RESEARCH SERVICE, LIBRARY OF CONGRESS; ACCOMPANIED BY CHRISTINE
      SCOTT, SPECIALIST IN SOCIAL POLICY, CONGRESSIONAL RESEARCH
     SERVICE, LIBRARY OF CONGRESS; AND DOUGLAS WEIMER, LEGISLATIVE
     ATTORNEY, CONGRESSIONAL RESEARCH SERVICE, LIBRARY OF CONGRESS

                STATEMENT OF JUDITH A. SALERNO, M.D., MS

        Dr. Salerno. Good afternoon, Chairman Hall and Members of
    the Subcommittee. My name is Dr. Judith Salerno, and I am the
    Executive Officer of the Institute of Medicine. I am also
    honored to have served veterans for nine years while in the
    Veterans Health Administration.
        I am here today to address topics that are pertinent to
    several of the bills that are being discussed, the topics
    covered in seven reports that are authored by Committees of
    experts convened by the Institute of Medicine. The reports are
    part of a long history of the IOM applying its expertise to
    assist the Department of Veterans Affairs by evaluating
    scientific evidence in a fair and unbiased manner, and drawing
    conclusions regarding health effects associated with exposures
    experienced by our Nation's veterans.
        My written testimony provides greater detail on all of the
    studies that I will summarize today. The first three studies I
    will discuss are Congressionally mandated, and ask the IOM to
    examine health outcomes related to exposures during the Vietnam
    and Gulf wars. H.R. 3795 would add a presumption of radiation
    exposure for the purposes of service connection for veterans of
    Gulf war and subsequent conflicts in that theater. The bill
    also calls for an independent study to determine diseases that
    may have resulted from these exposures.
        H.R. 6032 would provide presumption of service connection
    for Parkinson's disease for Vietnam veterans exposed to
    herbicides. IOM expert Committees concluded that there was no
    evidence to either support or rule out an association with
    numerous health outcomes related to depleted uranium and, in
    the case of Parkinson's, for exposure to herbicides which were
    used in Vietnam. The IOM is currently conducting an update of
    its 2000 report on DU. It is expected to be released this fall.
    And the Parkinson's update is due in 2009.
        With regard to H.R. 5454, the IOM expert committee examined
    the available scientific literature on ALS and veterans, and
    that report was released in 2006. Only five studies on the
    topic were identified. The Committee found that there was
    limited or suggestive evidence of an association between
    military service and the development of ALS.
        The next three reports generally covered disability and
    compensation issues. H.R. 1197 addresses issues related to the
    establishment of presumptions of service connection. A 2008 IOM
    report proposes an alternative scientific framework for making
    decisions regarding service compensation. Its findings and
    recommendations were previously delivered to the Subcommittee
    in February, and in the interests of time, I won't repeat these
    findings here.
        H.R. 5448 includes provisions for VA to update the rating
    criteria used to evaluate PTSD for compensation purposes, and
    to create a training and certification program for VA employees
    who perform the ratings.
        Last year an IOM Committee identified areas where changing
    current practice could result in more consistent and accurate
    ratings for disability associated with PTSD. The Committee
    found that the current criteria are overly general for the
    assessment of PTSD, and recommended that new criteria be
    developed and applied specifically to PTSD symptoms, and that
    these be grounded in the standards set out in the Diagnostic
    and Statistical Manual of Mental Disorders IV, which is used by
    most mental health professionals.
        The Committee also recommended that VA establish a
    certification program specifically for raters who deal with
    PTSD claims, with the training to support it, as well as
    periodic recertification.
        H.R. 5709 would require annual reviews of the accuracy and
    consistency of decisions on disability compensation. This
    report recommended periodic evaluations of the accuracy,
    validity, and inter-rater reliability of ratings across all 58
    VA field offices and body impairment categories.
        The main finding of this report, however, was that the VA's
    schedule for rating disabilities is badly out of date, and
    recommended that VA update the ratings schedule using current
    medical knowledge.
        Finally, H.R. 5954 would establish a mechanism for
    determining presumptive service connection for diseases that
    could be related to participation in Project 112, which
    includes Project SHAD. The 2007 report on Project SHAD found no
    clear evidence that specific long-term health effects were
    associated with the participation in Project SHAD; however,
    because of the limitations of the studies, in response rates,
    and the size of the study, the report's finding should not be
    viewed as clear evidence that there are no possible long-term
    health effects related to SHAD involvement.
        The Institute of Medicine is pleased to have assisted VA
    and Congress with its expert evaluations. We hope that we have
    contributed to improving care for our Nation's veterans. Thank
    you for the opportunity to address the Subcommittee. I would be
    happy to take any questions.
        [The prepared statement of Dr. Salerno appears on p. 67.]
        Mr. Hall. Thank you so much for your testimony, Ms.
    Salerno.
        Next, Mr. Sidath Viranga Panangala. Is that close to the
    pronunciation?
        Mr. Panangala. You are right.
        Mr. Hall. You are recognized for 5 minutes, sir.

                 STATEMENT OF SIDATH VIRANGA PANANGALA

        Mr. Panangala. Thank you, Chairman Hall, Ranking Member
    Lamborn, and Members of the Subcommittee. My name is Sidath
    Panangala from the Congressional Research Service. I am
    accompanied today by Christine Scott and Douglas Weimer, both
    from CRS. We are honored to appear before the Subcommittee
    today.
        As requested by the Subcommittee, my testimony will
    highlight major legislative milestones in the establishment of
    presumptions of service connection for veterans benefits. A
    copy of my full statement is submitted for the record.
        CRS takes no position on any legislation that is under
    discussion today. In general, a veteran is entitled to
    compensation for disabilities incurred or activated during
    Active military, naval, or air service.
        Currently, there are five ways to establish a disability is
    service-connected. First, there is direct evidence that the
    injury or disease was incurred while in military service.
        Second, in the case of a preexisting injury or disease,
    there is evidence that it was aggravated while in service.
        Third, through proximity to a service-connected condition;
    by example, veteran developing cardiovascular disease due to a
    service-connected amputation of the lower leg.
        Fourth, the injury or disease is caused by VA medical care
    or vocational rehabilitation.
        And finally, a service connection may be established by
    creating a presumption, either through statutory or
    administrative action, that a particular disease or diseases
    were incurred or aggravated by military service. Such
    presumptions, which are the focus of this testimony, relieve
    the veteran of having to prove that a particular disease was
    caused by exposure to a physical, chemical or biologic agent
    during his service.
        The legislative history of veterans' disease presumptions
    dates back to 1921, when Congress established a presumption of
    service connection with an amendment to the War Risk Insurance
    Act. This established presumption of service connection for
    tuberculosis and neuropsychiatric diseases, which today is
    known as psychosis, occurring within 2 years of separation from
    Active military service.
        In the following years, additions to the presumption lists
    were made by regulation, Executive Order, and legislation. The
    next major legislative change occurred with the enactment of
    Public Law 91-376 in 1970. This law established a presumption
    of service connection for seven categories of diseases and
    conditions for any veteran held as a prisoner of war.
        It should be noted that up until this time, all statutory
    presumptions had a presumptive period in which a disease or
    illness needed to have manifested itself. Typically this was
    about 1 year after separation from Active service.
        In the past 20 years, Congress has on three separate
    occasions created presumptive programs for three distinct
    groups of veterans, so-called atomic veterans, who were exposed
    to radiation from atomic above-ground nuclear tests and atomic
    bombs detonated in Japan; Vietnam veterans; and Gulf war
    veterans.
        In 1988, the Radiation-Exposed Veterans' Compensation Act
    established a presumption of service connection for 13
    specified types of cancers. That list was subsequently expanded
    first by legislation, later through VA administrative action,
    to 21 cancers.
        In 1991, the Agent Orange Act established for Vietnam
    veterans a presumption of service connection for diseases
    associated with exposure to Agent Orange and other herbicides.
    For the first time, this act required the VA to contract with
    the Institute of Medicine to conduct every 2 years a scientific
    review of the evidence linking certain medical conditions to
    herbicide exposure. The VA was instructed to use IOM's findings
    and other evidence to issue regulations establishing a
    presumption for any disease for which there is scientific
    evidence of an association with the herbicide exposure.
        In 1998, Congress enacted the Persian Gulf War Veterans Act
    and the Veterans Programs Enhancement Act. Similar to the Agent
    Orange presumptive program, these laws mandated regular and
    thorough reviews of the scientific and medical literature
    relevant to the health of Gulf War veterans by IOM.
        Next, as requested, I would briefly mention the IOM study
    on presumptive disability decisionmaking. In 2006, the Veterans
    Disability Benefits Commission requested IOM to provide a
    framework on how future presumptions should be made based on
    scientific principles. In 2007, IOM recommended the
    establishment of a permanent advisory Committee and a
    scientific review board. According to IOM, and I quote, the
    advisory Committee would consider and give priority to the
    exposures and health conditions proposed for possible
    presumptive evaluation, while the science review board, an
    independent body, would evaluate the strength of the evidence
    based on causation that links a health condition to military
    exposure, end of quote.
        Next, the independent science review board's report and
    recommendations would go to the VA for its consideration and
    implementation.
        In conclusion, since 1921, Congress has established
    numerous presumptions of service connection for a variety of
    health conditions affecting veterans. Establishing these
    presumptions, Congress and others have sought to balance the
    dual obligations of the VA to provide care for veterans who
    have been harmed by their service, and to do so in a manner
    that is equitable, scientifically sound, and accountable.
        This concludes my statement. I will be happy to answer any
    questions you may have. Thank you.
        [The prepared statement of Mr. Panangala appears on p. 70.]
        Mr. Hall. Thank you so much, Sidath. I appreciate your
    testimony. I just want to note that we are entering the
    attachments of the IOM studies referred to into the record,
    graphs and figures and so on that you were referring to, as
    part of the official record of this proceeding.
        Without objection, so ordered.
        [The attachments of the IOM study appear on p. 118.]
        Mr. Hall. Christine Scott, you are now recognized for 5
    minutes.
        Ms. Scott. Mr. Panangala presented testimony. We are here
    to help answer questions.
        Mr. Hall. Would you like to say anything?
        No. That is fine.
        Mr. Weimer.
        Mr. Weimer. Thank you, Mr. Chairman. My comments were
    delivered by Mr. Panangala.
        Mr. Hall. Thank you so much. They are in the record, and I
    appreciate you being here and submitting them.
        So we will now have, hopefully, a brief round of questions.
        Ms. Salerno, thank you again for joining us. The IOM's
    report, ``Improving the Presumptive Disability Decision-Making
    Process for Veterans,'' outlines a new paradigm for determining
    presumptions of disability compensation.
        Could you please elaborate on this new system, highlighting
    the differences with the current method? And please talk about
    the proposed science review board process.
        Ms. Salerno. Yes.
        The idea was to have a process which was clear and
    transparent. There seems to be--when charges come to the IOM or
    various committees to evaluate information, the charges vary as
    to how one should weigh criteria. With this new framework,
    there would be, first, an advisory panel, advisory to the VA,
    which would take into consideration all the views of
    stakeholders and evaluate the priorities for which conditions
    should be under consideration for presumption.
        Then the task would go to a scientific review board, which
    would evaluate, based on the best available scientific
    knowledge at the time, the process and make recommendations to
    VA.
        The VA would then take that information to the Secretary of
    Veterans Affairs, and based on clear and transparent criteria
    for what would be the threshold for presumption, would make a
    decision and put it into policy. So all along the way the
    process would be different.
        Mr. Hall. Thank you.
        Congressman Thompson introduced his joint letter, dated
    February 15, 2008, addressed to Dr. Rick Erdtmann of the IOM,
    detailing their issues with the IOM study.
        Were you aware of this letter, and can you give me an
    update on where the IOM stands on review and/or reopening of
    the 2007 study on the long-term health effects of participation
    in Project SHAD?
        Ms. Salerno. Yes, sir, I would be happy to.
        We did receive the letter and we looked at the five issues
    that were raised in the Congressman's letter. And we take their
    concerns very seriously, and we think they raise some very
    critical points for us to consider.
        So we have been open to thinking about how to discuss these
    issues that were raised, and we have decided that we would
    provide additional analyses of the data based on their concerns
    and questions. And we have done that.
        Now, these findings from the reevaluation of the data are
    being sent to an independent panel of national experts who have
    not been involved previously with any of the Project SHAD
    studies for an independent peer review. And then we will
    provide this information to the Congressman, and we hope it
    will address all of their concerns.
        Mr. Hall. With regard to point three of the letter, can you
    tell me what the potential impact on the results of the study
    was of omitting the health records of deceased Project SHAD
    participants, and is it possible that it skewed any of the
    results?
        Ms. Salerno. I have to see what point three is.
        Yes. The deceased for whom we didn't have any other
    information other than that they had died were, in the initial
    evaluation, not included except to note that they had passed
    away. It was a very small number relative to the over 5,500
    veterans who were exposed and included in the study. It was
    literally a handful.
        Attempts were made to obtain additional information on
    them, and we would be happy to consider additional information
    on these few veterans if and when they become available.
        Mr. Hall. Thank you. I think it is an interesting and valid
    question that Mr. Thompson and Mr. Rehberg were asking: If the
    cause-of-death information is available for those individuals,
    whether it is possible to measure what impact that information
    would have had on the outcome of the study.
        So if you could follow up on that and let us know.
        Ms. Salerno. Be happy to.
        Mr. Hall. I do not know in terms of relative size, what
    percentage you are talking about, but nonetheless I think it
    would be good to get an answer to that, if possible.
        I wanted to also ask briefly, Mr. Panangala, Parkinson's
    disease is already listed as a chronic condition under title 38
    of the U.S. Code, section 1101.
        In your opinion, is a separate presumption needed?
        Mr. Panangala. I believe the disease is in the title, but I
    think there is a time limit that is in the regulations and
    statute that you had to be diagnosed with. I believe the
    legislation needs to remove that time limit. That is my
    understanding.
        I can't say that that should be done or not, but that is my
    understanding of it, so I cannot comment beyond that
    explanation.
        Mr. Hall. If the 1-year presumptive window did not close
    for these conditions, would VA already be service-connecting
    those veterans affected by ALS even after a 1-year lapse after
    separation?
        Mr. Panangala. Can you repeat that question?
        Mr. Hall. Yes. If the 1-year presumptive window did not
    close, if it were not a factor in the VA's deliberations, would
    VA be service-connecting those veterans afflicted by ALS even
    after a year, post separation?
        Mr. Panangala. That means you are asking whether VA would
    go ahead and establish the presumption after----
        Mr. Hall. Does ALS manifest more than a year after
    separation or does the veteran sometimes take that long or
    longer to recognize the symptoms and come to VA?
        Mr. Panangala [continuing]. I cannot comment on that
    because I am not an expert. But we will be happy to get back to
    the Subcommittee after taking a look at that issue.
        [Mr. Panangala provided followup information in an October
    21, 2008, Memo, which appears on p. 70.]
        Mr. Hall. Thank you very much. My time has expired.
        I will now recognize Ranking Member Lamborn.
        Mr. Lamborn. I have some, but I am going to save them for
    another panel.
        Mr. Hall. In that case, Mr. Bilirakis.
        Mr. Bilirakis. I am fine, thank you. Thank you, Mr.
    Chairman.
        Mr. Hall. Mr. Bilirakis yields. So, you are in luck. Thank
    you so much for your testimony. It has been very helpful. You
    are now excused.
        Our second panel is excused. Have a lovely afternoon. Thank
    you for being here with us.
        Our third panel is called to the table. Les Jackson,
    Executive Director of American Ex-Prisoners of War; Steve
    Smithson, Deputy Director of Veterans Affairs and
    Rehabilitation Commission of the American Legion; John Rowan,
    National President, Vietnam Veterans of America (VVA);
    Lieutenant Commander Jack Alderson, USN, Retired, Ferndale,
    California; Jeff Faull, McEwersville, Pennsylvania, a disabled
    veteran, on behalf of the ALS Association; David Woods,
    Director of Veterans Affairs of Scott County, Iowa.
        We will take a moment while people get into their places.
    As usual, without objection, we will enter the written
    testimony into the record--without objection, so ordered--so
    other witnesses may feel free to shorten or lengthen their
    testimony as you like.
        Whichever it is, there is a five-minute clock. You will see
    the lights go from green to red, as usual.
        Thank you for joining us. Thank you for your patience with
    our having to run across the street and vote.
        Mr. Hall. We will start by recognizing Les Jackson,
    Executive Director from the American Ex-Prisoners of War.
        Mr. Jackson.

      STATEMENTS OF LES JACKSON, EXECUTIVE DIRECTOR, AMERICAN EX-
      PRISONERS OF WAR; ACCOMPANIED BY REV. JACK MATHISON; STEVE
    SMITHSON, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION
     COMMISSION, AMERICAN LEGION; JOHN ROWAN, NATIONAL PRESIDENT,
       VIETNAM VETERANS OF AMERICA; LIEUTENANT COMMANDER JACK B.
     ALDERSON, USNR (RET.), FERNDALE, CA; JEFF FAULL, MCEWERSILLE,
    PA (DISABLED VETERAN), ON BEHALF OF THE ALS ASSOCIATION; DAVID
        WOODS, DIRECTOR, VETERANS AFFAIRS OF SCOTT COUNTY, IOWA

                        STATEMENT OF LES JACKSON

        Mr. Jackson. Mr. Chairman, I recently returned from the
    Blind Rehabilitation Center, operated by the Veterans
    Administration in Connecticut. I am unable to read my
    testimony, and I have asked another former prisoner of war,
    Reverend Jack Mathison, if he would read the statement that the
    American Ex-Prisoners of Wars has prepared for this statement.
        Mr. Mathison. Chairman Hall, distinguished Members of the
    Subcommittee on Disability Assistance and Memorial Affairs, and
    guests. Thank you for inviting us to participate in your
    legislative hearing on several bills now pending in the House
    Committee on Veterans' Affairs. We will confine our remarks to
    House Committee bill H.R. 1197, the ``Improved Veterans
    Benefits for Former Prisoners of War.''
        Ninety-nine percent of former prisoners of war are from
    World War II and Korea and are now living in their sunset
    years. We are grateful that Congress has, through the years,
    provided benefits for former prisoners of war where it has been
    determined that the causal effect of an injury or illness is
    from the captive experience.
        For more than 50 years, the National Academy of Sciences
    has been conducting scientific research to identify medical
    conditions that, beyond any doubt, are the direct consequences
    of the brutal conditions of captivity. There are two medical
    conditions cited that still deserve presumptive status. These
    are osteoporosis and diabetes. Osteoporosis is bone loss
    attributed to starvation during captivity. Similarly, diabetes
    is the result of prolonged stress and permanent damage to the
    body's basic defense system as a result of months and years of
    grossly inadequate diet as a prisoner of war.
        These two proposed presumptives have, again, been
    introduced by Representative Gus Bilirakis, Republican of
    Florida. We are deeply thankful to him and strongly urge your
    Subcommittee's support by codifying these two conditions into
    law without further delay.
        Also very important to former prisoners of war and their
    survivors is House bill 156 to amend 38 U.S. Code to provide
    for the payment of Dependents Indemnity Compensation (DIC) to
    survivors of former POWs who died before September 30, 1999,
    with the same eligibility as applied to payment of DIC to
    survivors of former POWs who die after that date. This will be
    of great financial aid to the surviving spouses of POWs.
        We thank you for giving us this opportunity.
        [The prepared statement of Mr. Jackson appears on p. 74.]
        Mr. Hall. Thank you, sir, for your testimony and for your
    service. Mr. Jackson, thank you for your service to our
    country.
        We now recognize Mr. Smithson for 5 minutes.

                      STATEMENT OF STEVE SMITHSON

        Mr. Smithson. Good afternoon, Mr. Chairman and Members of
    the Subcommittee. I appreciate the opportunity to appear before
    you this afternoon to offer the American Legion's views on the
    various bills being considered by the Subcommittee today.
        The American Legion is generally pleased with the intent of
    these bills. Due to the time constraints this afternoon, I am
    going to limit my oral remarks to just a few of the bills being
    considered.
        H.R. 5985, the ``Compensation for Combat Veterans Act,''
    the purpose of this bill is to amend title 38, United States
    Code, to clarify the service treatable as service-engaged in
    combat with the enemy for utilization of nonofficial evidence
    for proof of service connection in combat-related disease or
    injury.
        A bill with similar intent, H.R. 5892, was recently passed
    by the Committee. Both title I of H.R. 5892 and this bill seek
    to define ``engaged in combat with the enemy'' under title 38,
    United States Code, section 1154(b) in a manner that is
    consistent with the realities of combat in today's world. The
    American Legion supports the intent of these bills.
        Given the evolving nature of modern warfare as reflected in
    the enemy's unconventional tactics in Iraq and Afghanistan, the
    American Legion is of the opinion that it not only makes sense
    to clarify the definition of ``engaged in combat with the
    enemy'' under 38 U.S.C. 1154(b) in order to adapt to the new
    realities of modern war. It is essential that we do so not just
    for those serving now, but for those who have served in the
    past and those who will serve in the future.
        H.R. 1198, the ``Prisoner of War Benefits Act of 2007,''
    the American Legion supports this legislation. It represents a
    solid step toward ensuring that former POWs receive the
    compensation and medical care to which they are clearly
    entitled. However, in addition to those diseases that will be
    presumed service-connected, the American Legion recommends that
    the list also include chronic pulmonary disease where there is
    a history of forced labor in mines during captivity, and
    generalized osteoarthritis as differentiated from the currently
    listed disability of post traumatic osteoarthritis.
        H.R. 5155, the ``Combat Veterans Debt Elimination Act of
    2008,'' although we agree with the intent of this bill, the
    legislation contains limitations and restrictions we do not
    support. The American Legion supports prohibiting the
    collection of debts in the case of any veteran who dies as a
    result of service-connected disability, not just those who die
    of a service-connected disability incurred or aggravated while
    serving in a theater of combat operations or in combat against
    a hostile force during a period of hostility.
        A veteran's death due to a service-connected disability not
    related to combat is no less tragic for the veteran's family
    than a death due to a combat-related service-connected
    condition, and we see no justification in making such a
    distinction.
        This bill also leaves it up to the discretion of the
    Secretary of Veterans Affairs to determine if termination of
    collection of the debt is in the best interest of the United
    States. It does not set forth any standards or criteria in
    determining whether or not termination of collection is in the
    country's best interest.
        Unfortunately, such vagueness will likely result in a
    restrictive interpretation, which will, in turn, limit the
    beneficial impact that was obviously intended. The American
    Legion has concerns over the exclusion from the prohibition of
    collection of debts involving housing and small business
    benefit programs.
        H.R. 5454: This bill, if enacted, would establish
    presumptive service connection of ALS for veterans who develop
    the disease to the degree of 10 percent of more disabling
    anytime after military service. The American Legion fully
    supports this legislation. The very nature of ALS warrants an
    indefinite presumptive period, as delayed diagnosis and even
    misdiagnosis is common with this terrible disease.
        The timeliness and appropriateness of this bill is further
    supported by research and other evidence in the last several
    years, including a November, 2006, IOM report that has
    indicated that those who served in the military are at greater
    risk of developing ALS than those who never served in the
    military.
        The last bill I will discuss this afternoon, H.R. 5954: The
    American Legion fully supports this bill, as it will put in
    place the process for establishing presumption of service
    connection for diseases that have been scientifically
    associated with exposure to the various agents and chemicals
    used in Project 112.
        This concludes my testimony, Mr. Chairman. I would be happy
    to answer any questions you or Members of the Subcommittee may
    have.
        [The prepared statement of Mr. Smithson appears on p. 74.]
        Mr. Hall. Thank you very much, Mr. Smithson. We will get
    back to you with questions shortly.
        Next, we will recognize Mr. John Rowan, National President
    of the Vietnam Veterans of America.

                        STATEMENT OF JOHN ROWAN

        Mr. Rowan. Good afternoon, Mr. Chairman, Chairman Hall, Mr.
    Lamborn, Mr. Bilirakis. You folks have been busy, to say the
    least.
        We have a formal statement that I would submit for the
    record which comments on all of the legislation in more depth.
    But there are a couple we just wanted to touch base on. You
    will also hear more from our colleagues at this table about
    H.R. 5944, the SHAD and 112 Project legislation.
        VVA was very much out front on this very early on, and we
    worked Mr. Alderson and Mr. LaChapelle and others and had the
    Subcommittee of the VVA to go after this whole SHAD-Project 112
    thing. We applaud Representatives Thompson and Rehberg for
    introducing and fighting for this legislation.
        If we have a caveat on any of this piece of legislation, it
    is the issue of the date 1963. We believe that we should go
    much sooner or earlier--or later, depending how you look it at.
    Prior to 1963, there were all kinds of other programs going on,
    and the DoD is finally starting to dig into this and letting us
    know all of these different programs that exposed people to all
    kinds of different things in addition to the SHAD and 112, the
    incidents. So we think that those veterans also are entitled to
    compensation for anything that may occur from their being
    exposed to all kinds of interesting chemical, biological, and
    other kind of agents.
        We also support H.R. 3008, about giving more help for rural
    veterans. One of our concerns, however, is, we would like to
    see the veterans service organizations, including the
    possibility of receiving those grants to help assist providing
    claims compensation and other kinds of programs out in the
    field. Many of our organizations have service officers who are
    out there, as well as the State and county folks, and many of
    them are out in the rural areas, and we would like to see,
    possibly including the VSOs, possibly be getting some of that
    grant money to help us do that.
        The more service officers, the better, in my opinion. We
    never have enough of them out there at all. Far too many people
    lose their opportunity to get fully compensated for their
    service.
        H.R. 3070, an interesting bill. We are interested in how
    you came up with $234 as a dollar figure. We think that was
    kind of interesting, and kind of low. We are really concerned
    about a lot of these compensation issues and a lot of the
    dollar amounts, quite honestly.
        DIC is another one, frankly, that needs to be looked at in
    where we go. Of course, the whole DIC-Survivor Benefit Plan
    (SBP) breakdown, people lose money because they are getting a
    pension benefit, which makes no sense.
        Basically, we primarily support all of these bills. We have
    nuances on each one of them, or most of them anyway.
        H.R. 5448, we are glad to see the elimination of this
    onerous requirement to prove stressors. For those of us who
    have been out in the field and had to file claims with
    veterans, I can tell you, having done that for a couple of
    years myself after I had retired back in 2002, it was very
    disheartening to have to sit in front and talk to a veteran who
    had gone through a year in Vietnam, did all kinds of strange
    and horrible things, but couldn't get him any compensation for
    his PTSD because he didn't have the right badge and the right
    award.
        Today, of course, we now know the most dangerous job in
    Iraq probably is being a truck driver. There were many truck
    drivers back in the days of Vietnam, as well, and people like
    that who had to go out in the field and were engaged in combat,
    were fired upon, had all kinds of things; but because they
    didn't get the right designation or didn't get the right badge
    because they didn't have the right military occupational skills
    MOS or occupational thing, that they didn't get considered the
    right stressor. Then we have to go through a whole song and
    dance and try to prove that stressor.
        So we applaud the Subcommittee on its activity, its
    actions, its trying to catch up on things. I agree with the
    Chairman, Mr. Filner, a lot of the bills are long overdue
    justice.
        Thank you.
        [The prepared statement of Mr. Rowan appears on p. 78.]
        Mr. Hall. Thank you, Mr. Rowan.
        Lieutenant Commander Alderson, you are now recognized for 5
    minutes.

                   STATEMENT OF LIEUTENANT COMMANDER
                     JACK B. ALDERSON, USNR (RET.)

        Commander Alderson. Thank you, Mr. Chairman, Ranking Member
    Lamborn, and distinguished Members of the Subcommittee. My name
    is Jack Alderson, I live in Ferndale, California. I am a
    retired U.S. Navy Reserve Lieutenant Commander.
        While on active duty, I was ordered to Project SHAD
    technical staff as officer in charge of the five Army Light
    Tugs. I was part of the technical staff for approximately 3
    years, and was involved in tests at Shady Grove, Big Tom, Half
    Note, and Folded Arrow; these tested biological weapons. The
    only ones that DoD has admitted to so far--and there were
    many--were Q fever and tularemia. Simulants used in the same
    conjunction were Bacillus Globigii, Serratia marcescens, and E.
    coli, all of which are known as hazardous to human health.
        We decontaminated the vessels using agents such as HTH,
    (chlorine), ethylene oxide, formalin, and betapropiolactone,
    all of which are highly carcinogenic.
        Each Army tug was manned by a Navy crew captained by a U.S.
    Navy lieutenant. The crews were hand-picked and had a security
    clearance of final secret. The mission of the tech staff,
    consisting of laboratory, ordnance personal and crews of the
    tugs, was to test at sea chemical and biological weapons. While
    in SHAD, I was involved in the training, planning and execution
    of tug operations.
        The written testimony describes test operations, including
    cleanup utilizing the named highly carcinogenic chemicals.
    Here, I stress, we know that the weapons and simulants
    penetrated the tugs. SHAD training used the simulants and
    chemical decontamination agents often in training; in other
    words, we were exposed to health hazards almost continuously,
    and what we used as training was what the other vessels that
    were involved in 112 and so forth considered as being in a
    test.
        When departing SHAD, we were forcefully debriefed to say
    nothing about our time in SHAD. With that secrecy, it was not
    until the early nineties that I became cognizant of the health
    problems of SHAD personnel. When health problems occurred and
    the SHAD personnel went to the VA, they were shown the door.
    Many went to their veteran service officers but were admonished
    that the U.S. Government would not treat service personnel that
    way.
        Let me give you three examples. Lieutenant Ken Frazier, who
    happens to also be Congressman Thompson's constituent,
    skippered the 2085. He received the letter from VA and twice
    traveled to the VA facility in Oregon with it in hand. He was
    turned away both times, as they didn't know anything about
    SHAD. Ken died of cancer of the esophagus and lungs in 2004.
    Ken's widow is worried about her health and her daughter's
    health.
        Larry Pilkinton was a hospital corpsman with 15 years
    commendable service. He had a final secret and interim top
    secret clearance. He was bit by serin while loading bomblets on
    the Big Island. He was transferred from Tripler to Oak Knoll
    Naval Hospital, where he was discharged as having prior mental
    problems before enlisting in the U.S. service. Larry received
    no help from the VA, and died May 29, 2007. His widow has no
    benefits.
        Homer Tack was a sailor in Copperhead on board the USS
    Power. He has very serious pulmonary problems. Recently, his VA
    tests and private tests have shown the seriousness of the
    problem. It has been over 200 days since the tests were given,
    and still no decision by VA.
        We were ordered to SHAD to test chemical and biological
    weapons and then clean up with after the test. The cleanup was
    done with harsh carcinogenic chemicals.
        DoD, for security reasons, has not disclosed all weapons
    tested in SHAD. In fact, in the Shady Grove fact sheet they do
    not even list the decontamination agents that I have listed
    here. I have just named them and can attest to what they were
    because I was involved in the utilization and the testing.
        Without full disclosure of the biological and chemicals use
    in SHAD operations, the VA cannot equate problems of health and
    SHAD exposure. The veterans seriously need H.R. 5954 to assist
    in helping with their problems acquired during their very
    unique service to our Nation.
        Thank you.
        [The prepared statement of Lieutenant Commander Alderson
    appears on p. 83.]
        Mr. Hall. Lieutenant Commander, thank you so much for your
    testimony and your service to our country and your service to
    your fellow veterans, especially those who were exposed during
    these tests.
        Next, we will recognize Jeff Faull, disabled veteran, on
    behalf of The ALS Association.

                        STATEMENT OF JEFF FAULL

        Mr. Faull. Good afternoon, Chairman Hall, Ranking Member
    Lamborn, Members of the Subcommittee.
        As you said, my name is Jeff Faull. I am from a small town
    in northeastern Pennsylvania, McEwensville. I appreciate the
    opportunity to speak with you this morning on behalf of the ALS
    Association and the veterans living with ALS. I hope that by
    sharing my experience with you today, you will gain a better
    understanding of how this disease impacts vets across country,
    and why H.R. 5454 is so urgently needed.
        Before I begin, I would like to thank Congressman Henry
    Brown and Congressman David Price for their leadership in
    introducing this vital legislation. Veterans with ALS across
    the country are truly grateful for their efforts.
        I joined the Navy in 1992 at the age of 24, and served two
    tours of duty as a nuclear electronics technician, including 4
    years aboard the USS Theodore Roosevelt. During that time I
    participated in Operation Southern Watch Deliberate Force,
    Allied Force, and Noble Anvil. Prior to my assignment aboard
    the Roosevelt, I was stationed at Knolls Power Laboratory
    Kesselring Site in West Milton, New York, located not too far
    from your district, Mr. Chairman.
        I left the Navy in 2000 to spend more time with my wife,
    Tammy, and our daughters Tiffany and Breanna. Like many other
    veterans, I never thought that my service in the military would
    cause health problems years after I left the service. I never
    thought that I would have to fight to obtain benefits from the
    VA. I never thought I would be sitting here today before you
    with a diagnosis of ALS, or Lou Gehrig's disease.
        For me and thousands of veterans across the country, the
    reality is that years or even decades after serving the country
    we are being diagnosed with ALS, and we are fighting for
    benefits at the same time we are fighting this disease.
        I was diagnosed with ALS just over a year ago in February,
    2007, at the age of 38, about 20 years younger than the typical
    person with ALS. At the time, I had no idea what ALS was.
    Amyotrophic lateral sclerosis meant nothing to me, as I am sure
    it means nothing to thousands of others when they are first
    diagnosed, but I can assure you it is a whole different story
    when the doctor looks at you and says, ``Unfortunately, you
    don't have cancer.'' That is when you begin to understand how
    serious ALS really is.
        ALS is a rapidly progressive and invariably fatal
    neurological disease that attacks the neurons responsible for
    controlling voluntary muscles. To put it simply, this disease
    will rob me of my ability to walk, talk, move, and breathe.
    There is little I can do to slow the progression, as there is
    no effective treatment and no cure. The disease is usually
    fatal in about 2 to 5 years. In fact, of the more than 2,000
    veterans who are enrolled in the VA ALS registry over the past
    4 years, less than 900 are still with us today.
        I first noticed the symptoms of ALS as early as 1999 when I
    experienced cramps and twitching in my left hand and arm. As
    time passed, I began to develop weakness, then loss of muscle
    mass, which eventually led to my diagnosis last year. Since the
    diagnosis, the weakness and atrophy have spread and gotten
    worse. Both hands and arms are now weak, walking is becoming
    more difficult; and as you can hear, my speech is beginning to
    be affected. I keep a pair of slip-joint pliers in the kitchen
    to open things. My wife, Tammy, who is with me here today,
    normally makes sure that things like cereal boxes are open for
    me. Otherwise, I have to ask for help from my daughters.
        Although they have no problems helping their old man, it is
    not how I pictured spending my time with them. I can't make the
    walk to see Breanna play soccer. I don't have the arm strength
    to shoot basketball with Tiffany. I will more than likely be in
    a wheelchair when it comes time to teach them to drive.
        These are the treasures this disease steals from thousands
    of veterans every year before it takes our lives. In fact, I
    understand that recent research, which has not yet been
    published, suggested ALS is occurring at even greater rates in
    those serving in the conflict in Iraq.
        Past studies have shown, a Harvard study, that all
    veterans, regardless of time and place of service, are almost
    twice as likely to develop ALS. What is alarming about this
    information and the evidence from prior research is that we are
    seeing ALS at an age when we generally do not see the disease.
    I was 38 when I was diagnosed. Most people diagnosed are in
    their fifties, sixties, or seventies.
        What will we see 10, 15, 20 years in the future as the men
    and women serving today leave the military? It is clear that
    regardless of when and where someone served the military, they
    are at a greater risk of dying from this disease than if they
    had not served in the military.
        Despite the evidence showing that all U.S. military
    veterans are at greater risk of ALS, the VA has not created a
    presumption of service connection for all veterans with ALS.
    Thousands of veterans continue to be left behind, and hundreds
    of thousands serving in the military today, including in Iraq
    and Afghanistan, continue to be at a greater risk of dying from
    this disease.
        The VA will respond that any veteran with ALS can be
    service-connected on the basis of specific evidence supporting
    their case. As someone who has been denied service connection
    and knows countless others who have, as well, I can tell you
    that this response demonstrates a lack of understanding of this
    disease.
        The reality is that the majority of veterans with ALS who
    do not fall under the current limited presumptions are forced
    to fight for their benefits, and we are usually denied. I have
    been attempting to establish service connection for over a year
    now and have submitted reams of scientific and medical
    evidence, including letters supporting my claim from my
    neurologist. Yet, that evidence has fallen on deaf ears.
        Part of the problem we face is the nature of the disease
    itself. ALS is an insidious disease. First, the symptoms, such
    as the ones I experienced while on active duty, are so benign,
    they often go unreported. How many of us in this room have
    experienced muscle cramps and twitching and thought nothing of
    it? They are symptoms of ALS. Yet, they are not documented in
    our service medical records simply because we did not think
    them a big deal at the time. How many of us on active duty
    actually thought we would succumb to muscle twitching?
        In addition, it can be years from discharge until the onset
    of symptoms or between onset and diagnosis, while after the 1
    year presumptive period has ended and there is no simple way to
    diagnosis ALS, no single test you can take that says you have
    ALS. Rather, there is a diagnosis of exclusion, ruling out
    every other possible diagnosis.
        The bottom line is that if you are not diagnosed while on
    active duty and did not serve in the Gulf, the VA likely will
    not consider ALS to be service-connected, despite the studies
    and the fact that the VA and DoD both recognize ALS is a high
    priority of research. In addition to the studies that I have
    referenced, there are multiple peer-reviewed studies linking
    ALS to many of the things our military personnel are exposed to
    on a regular basis. These include ionizing and nonionizing
    radiation, fuels, solvents, lead, vapors, and vaccinations.
        My question as a veteran with ALS trying to establish a
    connection is, what additional proof must I provide? How many
    more studies are needed? How many veterans have to develop ALS
    and die from it before the VA takes action?
        I can only hope this quick glance into my life with ALS and
    attempts for service connection grant you the understanding to
    see the importance of establishing a presumption of service
    connection for all veterans with ALS, which is exactly what
    H.R. 5454 will do.
        We have to fight for our lives. We should not also have to
    fight for the benefits the evidence shows we deserve.
        Abraham Lincoln's statement, which was later adopted by the
    VA as their motto states, ``To care for him who shall have
    borne the battle and for his widow, and his orphan.'' I, and
    the other veterans with this horrible disease, appreciate your
    time and effort to ensure that that statement is more than
    words. I urge you to support H.R. 5454 and help ensure that no
    veteran with ALS is ever left behind.
        Thank you again for your time and the opportunity to speak
    with you.
        [The prepared statement of Mr. Faull appears on p. 85.]
        Mr. Hall. Thank you very much, Mr. Faull. Thank you for
    your service to our country. Thank you to your family for your
    sacrifice as well.
        How many more studies are needed?
        Mr. Faull. That question I have now the evidence shows----
        Mr. Hall. It's a rhetorical question, you have enough
    studies.
        I am thinking about a Bob Dylan line about how many years
    must a mountain exist before it is washed to the sea. But we
    won't go into that at this time.
        Our next witness is David Woods, the Director of the
    Veterans Affairs for Scott County, Iowa.
        Mr. Woods, you are recognized for 5 minutes.

                        STATEMENT OF DAVID WOODS

        Mr. Woods. Mr. Chairman, thank you for allowing me to be
    here today to discuss Congressman Braley's bill on the
    compensation for combat veterans.
        I am the Director of Veterans Affairs for Scott County in
    Iowa. I am also a Vietnam veteran. I have been awarded the
    combat infantry badge (CIB), the Purple Heart and the Silver
    Star. I was wounded June 12, 1970. Happy anniversary. So I have
    a feeling for just what our veterans are going through today.
        My job as a veterans service officer in Scott County is to
    listen to these veterans, get them their medical help and the
    compensation that is due them. I also help them through the
    Veterans Administration, the tangle of paperwork that they have
    to go through, and make sure that they understand what they are
    entitled to for their benefits.
        Having witnessed, through my combat experiences, I
    understand and am able to talk to these veterans, and they will
    sit there and tell me things that they have never told their
    families, their wives, or anyone else. Because I have been in
    combat, they can talk to me about it.
        I have had veterans come into my office, and after asking
    them where were you at, when were you in a certain area, what
    unit were you with, or who was wounded or killed by you, they
    look at you and stare off into space because they have no idea.
    They forgot that stuff.
        Now, how about the Vietnam veterans who have been trying to
    forget about his time 40 years ago? The cases of PTSD have
    risen because of the Iraq-Afghanistan war. After 40 years of
    him trying to forget where he was at or what he was doing, and
    then now asking him to try to remember where he was at on a
    certain date or where he was at, what people were injured by
    him, it is just impossible. They look at you and they have no
    idea because they have been trying to forget this horrible
    memory for years.
        For our Iraq-Afghanistan veterans, there are times when
    that military police or engineer or even a cook might be pulled
    from his job and sent on convoy duty. Many times when that
    change happens, it is not documented in their files. Then, when
    he is sent on that job, he might not be working with his own
    unit or his combat buddies. Then, if they receive incoming
    rounds, it is not documented because it is an everyday
    occurrence for a lot of them over there.
        I have had National Guard veterans come into my office and
    apply for compensation, because they have come in and we have
    applied through the VA, they have been turned down by the VA
    mainly because his part of the unit has come back to the
    country; another part of his National Guard unit might still be
    overseas, and those records are still over there. So then that
    veteran has to go out there and, as mentioned before, find a
    buddy from his combat unit that witnessed something and write
    it up. Then we have to put it through the VA to have them
    accept it. This is not right.
        I have had an Iraqi veteran with TBI, traumatic brain
    injury, file for compensation, but because he had no CIB,
    Purple Heart, or other combat medal, he was turned down by the
    VA for his compensation. His DD 214, his discharge papers show
    that he was in Iraq, listing the date and unit, but nothing
    else. When we filed the compensation claim, that veteran was
    treated at the Iowa City VAMC medical center. He was found to
    have TBI and he was awarded his compensation.
        If you were to ask a combat medic what his job was, he
    would tell you that he was to keep that injured soldier alive
    and let the people in the background do the paperwork. If you
    were to look at my medical report, it says that I was injured
    in the left arm and the neck. Neither happened to me when I was
    hit. That medic did not carry a file for every soldier that is
    out in the field; that is not his job. So there is no way of
    knowing just what a soldier went through or where he was hit,
    or whatever, a lot of times until later on. It is still not
    possible today to keep these records.
        Case in point: I had a World War II veteran come into my
    office wanting to get his Purple Heart, which he had never
    received. His records were burned up in the big fire in St.
    Louis. He just kind of thought nothing of it, but his family
    wanted the Purple Heart.
        He came into my office. We filed the paperwork with the VA.
    They said, nope, can't find anything at all on him. So I did
    some phone calls, found out that I could write a letter to the
    Unit Records section down in St. Louis. We did that.
        The gentleman got his paperwork from the Unit Records
    section. He brought it into my office. I read it, and he said,
    What do you think, Woody? I said, You're dead in the water,
    because it had him down in the medical records for an illness,
    not being wounded over in Germany. As far as the buddy
    statement, his tank crew members were all killed when he was
    hit and injured. So his Purple Heart, I did not get.
        I have had a Vietnam veteran come into my office to apply
    for compensation for Agent Orange type 2 diabetes. That veteran
    was a deepwater Navy veteran. And when we applied for the
    compensation, of course, the VA came back with the Haas v.
    Nickelsen case, saying he was never in Vietnam. I asked the
    veteran if he had contact with any of his fellow Navy
    personnel, and the next day he came into my office with two e-
    mail addresses.
        I sent off an e-mail to the gentleman. I got an answer back
    the very next day. The gentleman was the third ranking officer
    on his ship. His ship was permanently stationed right off of
    the tip of South Vietnam. The third officer sent me the letter
    saying it was common knowledge that replacement sailors would
    fly into Vietnam, take 2 days to truck down to the southern
    part of Vietnam, be boated out to the ship, and then, really to
    add insult to the VA and the Navy records, the same gentleman
    told me that every 2 to 3 months they would go onto an island
    off of South Vietnam and have volley ball and R&R.
        So definitely this gentleman was in country and definitely
    he should have been connected for his type 2 diabetes. We are
    still waiting from the VA on that case.
        These are just a fraction of the compensation claims that
    we are fighting with the VA.
        These last wars are not like World War I and World War II
    where you knew who your enemy was or where the frontlines were.
    Now we have no lines or enemies in a certain uniform. There are
    not many safe areas for our veterans of today, who can actually
    relax. It doesn't take much incoming to put stress and pressure
    on our veterans, and that is what we are finding out today.
        Thank you for letting me speak to you today.
        [The prepared statement of Mr. Woods appears on p. 87.]
        Mr. Hall. Thank you, Mr. Woods.
        Without objection, I will ask Mr. Bilirakis if he would
    like to start off our questioning at this time.
        Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
    very much. Thank you, gentlemen, for testifying today, and
    thank you for your service.
        Mr. Jackson, do you have an estimate on how many former
    prisoners of war are living today?
        Mr. Jackson. It seems to me that it is 2,000.
        No, 20,000
        Mr. Bilirakis. About 20,000. What is the average age, would
    you say?
        Mr. Jackson. I have been the average age for a long time,
    of our group, which is, today I am 87 years old.
        Mr. Bilirakis. Eighty-seven.
        How many would you estimate would benefit from this bill,
    H.R. 1197?
        Mr. Jackson. I honestly don't know. But I know that they
    are out there.
        Mr. Bilirakis. Okay. Thank you very much.
        Does anyone else want to answer those questions? Okay.
    Thank you very much. We will do the research. I appreciate it,
    Mr. Jackson. Thank you.
        No further questions.
        Mr. Hall. Thank you, Mr. Bilirakis. I would like to ask Mr.
    Jackson, I know that adding osteoporosis and type 2 diabetes
    have been priority presumptive conditions that your
    organization has wanted to add to the list, and that you are
    awaiting passage of S. 1315, which contains a provision to add
    osteoporosis for those afflicted with PTSD to this list.
        Are you aware of any other conditions that you think
    deserve presumptive status for former POWs?
        Mr. Jackson. No, sir, I am not.
        Mr. Hall. The VA's testimony states that it is unaware of
    studies that associate type 2 diabetes or osteoporosis with POW
    internment. What evidence is your organization aware of that
    they are not, which would show the connection to be more
    likely?
        Mr. Jackson. The National Sciences Foundation has done
    studies on it and presented them yearly for many years.
        Mr. Hall. We will make sure we pass it along to the VA.
        Mr. Smithson, pertaining to H.R. 3008, in your mind, what
    distinguishes rural veterans from veterans in metropolitan
    areas that would make this legislation necessary?
        Mr. Smithson. I'm sorry. Can you repeat that question?
        Mr. Hall. What distinguishes rural veterans from veterans
    in metropolitan areas, which would make H.R. 3008 necessary?
        Mr. Smithson. They often have a lack of resources, access
    to information. They may be far away from a VA facility. They
    may also not have access to service officers. A lot of rural
    areas have limited resources as far as county service officers
    and even veterans service organization service officers.
        Mr. Hall. I would imagine the cost of gasoline is probably
    complicating things, too
        Mr. Smithson. Probably, yes.
        Mr. Hall. Mr. Rowan, it sounds like VVA has had an involved
    history of advocating for SHAD veterans. What is your response
    to the IOM testimony that claims there is no clear evidence
    that associates Project SHAD participants with ill health
    effects? Does VVA have any additional data, a database of
    veterans who report being sick because of SHAD, and how would
    you suggest rewording the clause so that it better specifies
    the meaning of biological and chemical?
        Mr. Rowan. Actually, my friend, Mr. Alderson here, can
    probably answer those questions a lot better because they are
    much more familiar with it. Other than to say it was not only
    the fact of what they used and what the experiments were, but
    the cleanup was probably as dangerous as the original
    experiment because the caustic chemicals were just as bad.
        He has done a whole lot more study on this. One of
    interesting things, apparently DoD is starting to catalogue all
    these folks who have been exposed to all of these different
    programs. We can find out who they were.
        Mr. Hall. Let me take the suggestion and ask the same
    question of Lieutenant Commander Alderson.
        Commander Alderson. Yes, sir. One of the things that was
    disappointing to us is that they found that our crews of our
    LTs--each LT only had a crew of 10, with a lieutenant as
    commanding officer, for a crew of 11.
        But they did not count the laboratory people or the gunners
    mates who were loading and mixing the weapons, that were
    loading them onto the Marine aircraft that were coming over and
    escorting us. Those, we felt, were also part of the Project
    SHAD technical staff. But if you leave it just to the tug
    crews, you come down with this minor number.
        If you take the whole Project SHAD technical staff from the
    beginning to the end, with normal rotation because this is a
    permanent change of duty station, I would guess that there was
    somewhere between 400 and 500 veterans.
        They also didn't have a ship that they could compare the
    LTs to. I gave them the name of the U.S. Koka, which was a
    small Navy tug that operated out of the same area that we did
    on the docks there in Pearl Harbor.
        Mr. Hall. Commander Alderson, given your direct experience
    with Project SHAD, what would you like to see done in the way
    of followup to give veterans like yourself, who are suffering
    as a result of exposure to various elements used during these
    experiments, some measure of justice, although delayed justice?
        Commander Alderson. First of all, I would like to make sure
    that our health is taken care of. In cases where we are talking
    about, like Mrs. Pilkinton, she has no widow benefits, and she
    is definitely a widow of SHAD because we were there when Larry
    got bit.
        I would like to see those things happen. I would like to
    have--when studies of our operations done and our exposures
    examined, I would like to have Commander Norman LaChapelle and
    myself, people who were involved in the planning, operation,
    and execution of the tests, be part of the panel, at least be
    closely consulted with what actually occurred.
        I think one of the problems that is with the IOM study is
    that they never had a clear idea of what we did and how we did
    it. When they tested the rest of the United States Navy ships,
    they did not ask the crew what their job was, and the signal
    men on the flying bridge certainly had more exposure than the
    radar operator in the combat information center, who is in a
    temperature, dust and humidity-controlled atmosphere, or the
    guy in the firing flat in the boiler room, in the heat. He is
    standing under the heavy-duty air flowing down, not only to
    give him something to cool off and breathe, but that air goes
    in and fires the boiler. So he is under a tremendous amount of
    exposure.
        This is one of the major errors of trying to equate what
    that exposure was during the tests.
        Mr. Hall. Speaking as a sailor who has had a number of
    power and sailcraft--smaller ones, I am sure--at one time we
    had a diesel leak from one of the tanks that sprang a leak, and
    it took forever to get the odor out of the hull. No matter how
    many times you scrubbed it with different agents, it seemed as
    if it permeated the fiberglass, to some degree.
        I am sure the same is true of these agents that you were
    being tested with.
        Commander Alderson. I said that Mrs. Frazier was worried
    about her health and her daughter's health. When we were out on
    the test, using hot weapons, that was different. When we were
    working out of Pearl, and we were training on a daily basis
    using some of the same chemicals to clean up with and so forth,
    there were no washing machines on the tugs. When Ken came in,
    he took off his uniforms and so forth, and Leah washed his
    clothes with hers and her daughters.
        Mr. Hall. And they were all exposed to lower levels of the
    same contaminant?
        Commander Alderson. Yes, sir.
        Mr. Hall. Or weapon. Thank you very much for your testimony
    and for your service and your patience. I am sorry. I guess
    this is one of those times when somebody should apologize to
    you on behalf of your government. So I will presume to do that.
    I get e-mails from some of the test vets on a pretty regular
    basis, from all kinds of tests that can't be talked about
    because they are so highly-classified or secret, when I hear
    secret it kind of has a bad ring to it.
        But anyway, I would like to ask Mr. Faull, a 1-year time
    period does not seem to take into account the nature of ALS,
    since the disease is difficult to diagnose and can in fact go
    undiagnosed for some period of time. It is also a disease that
    may manifest itself years after discharge, well after younger
    veterans leave the service. Do you think the VA's current
    policy is adequate?
        Mr. Faull. No. As I said, I have been trying to establish
    service-connection for over a year now. You heard some of the
    testimony today talking of buddy letters, et cetera. I have
    given those. I have given the scientific proof. And as I said,
    deaf ears.
        Mr. Hall. You mentioned the Harvard study and the World
    Health Organization (WHO) guidelines. How are these different
    from the IOM study?
        Mr. Faull. The IOM study was a review of all the studies
    done to date. I think as we heard earlier, it was five. And
    that looked at all of those studies and said that ALS, as--the
    military as related to the development of ALS, it is an
    increased risk. The WHO studies, the guidelines were utilized
    at least in my case for the vaccinations, and came back as a
    possible cause of ALS.
        Mr. Hall. Thank you. Thanks again for your service and your
    sacrifice. Last, I would like to ask Mr. Woods, in your
    statement you identified two problems as a service officer, the
    first being with records that are still with the units on
    deployment or when documentation simply did not occur. I have
    also heard that getting documentation can be difficult when
    records are classified. So what do you do as a service officer
    when such problems exist? Second, in your opinion does VA give
    the veteran the benefit of the doubt as required by statute?
        Mr. Woods. I would like to answer that last question first.
    No. They definitely do not give the veteran the doubt at all.
    It should be that they should believe the veteran more, but
    they say, hey, by our records here we don't show it, so they
    shoot the veteran down. For me, I have learned now that I can
    go ahead and contact, like I said, the unit records section.
    Since the records were burned up in the personnel files, the
    unit records are still pretty much intact. Also by using the
    buddy statements, that is an important thing to use anymore.
    Sometimes the VA will accept the buddy statement.
        I have had a case where a gentleman came in, complained
    about a back injury. He jumped into a trench during incoming
    rounds, he had a gentleman land on his back, injured his back,
    had a couple of aspirin for it later on. Well, later on in life
    it bothered him more, and he remembered about the gentleman
    jumping on his back. The VA has no records of it because it was
    just, you know, a medic would give him some aspirins and that
    was it. We were able to actually track down the two veterans
    that were in on the case of jumping on the gentleman's back. I
    sent the information to the VA, along with the Social Security
    number, and we got a letter back from the VA saying, well, we
    need more information. What unit was he with? Because he came
    over with a Guard unit, actually, from over in Vietnam. So we
    had to send more information in. And it is hard to get them to
    accept that.
        Mr. Hall. Thank you, sir. My time is long expired. I will
    now recognize our Ranking Member, Mr. Lamborn.
        Mr. Lamborn. Thank you, Mr. Chairman. First of all, I want
    to thank you, Lieutenant Commander Alderson and Mr. Faull, for
    your service to our country. This question is for Mr. Rowan and
    Mr. Smithson. Understanding that we have some bills here that
    can be very beneficial to veterans, we still have to address
    the PAYGO issue. How do you suggest that we address PAYGO for
    bills, these bills, or bills like this? Help us with this
    situation.
        Mr. Rowan. One of my concerns about this whole PAYGO
    business, and we hear this not only in this, we have been
    hearing it in the GI Bill issue as well, we don't hear PAYGO
    when we hear how much we have to spend in Iraq every day. We
    never hear that. Why? Because it is part of a war. Well, I hate
    to say it, but we are all part of a war. We may be coming 20
    years after the war or 30 years after the war, but we are all
    part of the war. And so I think that I get a little concerned
    about PAYGO just as a political issue here being utilized when
    it comes to veterans benefits. That is number one.
        Number two is oftentimes the veterans benefits, unlike
    every nickel that is being spent in Iraq, will actually come
    back to help the society. It is given to the veteran. I mean,
    the veteran isn't going to run off and just make that money
    disappear. He is going to probably use it to pay for the gas
    that got increased last month or whatever, to pay for their
    life. By the time we end up getting these veterans these
    benefits it is oftentimes, and Mr. Woods can tell you, so far
    after the fact, when people have usually been beaten down into
    destitution, that this is barely compensating to keep them
    alive. And yet that money still gets recirculated back in their
    community and ends up having some sort of impact.
        Having spent a lot of life in government, I can tell you
    the economists tell you every nickel you give out ends up
    coming back about 16 times in various ways in the economy,
    which is why we give all these benefits away to corporations
    and things to do things, build things, and move people into
    their community. And I think that the veterans benefits, just
    again as a practical thing, is part of warfare. And if we are
    not willing to pay for it, don't send us anywhere.
        Mr. Smithson. I would just like to echo that. It is part of
    the cost of war. And several of these bills, it is about doing
    the right thing. And for example, H.R. 51--what is it, H.R.
    5985, recognizing the change in warfare today, in that for
    example the conflicts in Iraq and Afghanistan that anybody over
    there in those two theaters are exposed to combat no matter
    what they are doing. And changing the law to recognize that is
    the right thing. And changing that is a cost of war.
        So I understand your concerns about how to pay for it, but
    doing the right thing is doing the right thing. And there is
    always enough money to send troops into harm's way, but it
    seems when it comes time to pay for it after the fact we are
    always concerned about that. And again, doing the right thing
    is doing the right thing.
        Mr. Lamborn. And for the record, I didn't vote for the
    PAYGO rule. However, it is something that we are allegedly
    following, so I just had to ask that question, or these bills
    won't be able to go forward. So, thank you for your answer.
        I yield back, Mr. Chairman.
        Mr. Hall. Thank you, Mr. Lamborn. For the record, I would
    say that once upon a time the conservative approach would have
    been to pay for the war rather than have a war on borrowed
    money, and also pay for the veterans benefits. So we should
    probably be consistent and either pay for them both, all of it,
    or borrow all of it. But at any rate, I agree that we cannot
    consider the veterans to be separate from the war itself in
    terms of its urgency and its worthiness of funding.
        Mr. Rowan, you wanted to comment on that?
        Mr. Rowan. Yeah, I just wanted to add one other thing with
    regards to the gentleman with regards to the ALS. There are
    many instances where we see problems with disease that doesn't
    necessarily manifest itself until many years after the fact. I
    mean, I still get a laugh every time I read the fact when we
    talk about the presumptives of Agent Orange, and we had
    chloracne, but it has a year time. Well, my year after Vietnam
    actually I did, I had all kinds of chloracne, but I didn't know
    what the heck it was until 20 years later. So we get all of
    these crazy things.
        I have often seen, and we even had some adjudicated cases
    on it, and we actually won a case on a guy who had heart
    disease. And we proved that even though his diabetes came
    later, was diagnosed later, we actually proved he was probably
    prediabetic, which led to his heart condition, and got the
    heart condition as a secondary to the diabetes.
        So you got all of these things that take so long to do. And
    so I applaud the efforts to try to, especially ALS and
    Parkinson's, add them to the list.
        Mr. Hall. Thank you so much, Mr. Rowan, and thank you to
    our entire panel. We could have a long discussion about this,
    but given the lateness of the hour and the fact that there is
    another panel waiting, we will save that for another time. You
    are excused, and thank you very much for your testimony and
    your service to our country.
        And we will ask our fourth panel to join us at the table.
    Bradley G. Mayes is the Director of Compensation and Pension
    Service for the Veterans Benefits Administration (VBA),
    accompanied by Bradley B. Flohr, Assistant Director for Policy,
    Compensation and Pension Service of the VBA, and Richard
    Hipolit, Assistant General Counsel of the U.S. Department of
    Veterans Affairs.
        Thank you, gentlemen, for your patience, and it is good to
    see you again. Welcome. Of course without objection your entire
    statement is entered into the record and feel free to deviate,
    elaborate, or edit as you wish. Mr. Mayes, you are recognized
    for five minutes.

    STATEMENT BRADLEY G. MAYES, DIRECTOR, COMPENSATION AND PENSION
     SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF
     VETERANS AFFAIRS; ACCOMPANIED BY BRADLEY B. FLOHR, ASSISTANT
    DIRECTOR FOR POLICY COMPENSATION AND PENSION SERVICES, VETERANS
     BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
    AND RICHARD HIPOLIT, ASSISTANT GENERAL COUNSEL, U.S. DEPARTMENT
                          OF VETERANS AFFAIRS

        Mr. Mayes. Thank you, Mr. Chairman, Ranking Member Lamborn.
    Before I get started, I did want to recognize the members of
    the previous panel and thank them for their service and for
    helping educate me, Commander Alderson and certainly Mr. Faull.
    We can't know what Mr. Faull is going through, clearly.
        I am pleased to be here today to provide the Department of
    Veterans Affairs' views on pending benefits legislation.
    Accompanying me is Brad Flohr, Assistant Director for Policy in
    the Compensation and Pension Service, and Mr. Richard Hipolit,
    Assistant General Counsel.
        We are still reviewing H.R. 5448, and will provide views on
    that bill in a subsequent views letter.
        [The VA failed to provide Administration views for H.R.
    5448 and H.R. 3795.]
        I would like to begin by sharing our views on H.R. 5155,
    the ``Combat Veterans Debt Elimination Act of 2008.'' I believe
    that was introduced by Congresswoman Shea-Porter. This is the
    only bill I will be testifying on today which the
    administration is able to support.
        This bill would prohibit VA from collecting all or part of
    a debt owed to the United States under any program under the
    laws administered by VA who dies as a result of a service-
    connected disability incurred or aggravated while serving in a
    theater of combat operations in a war after the Persian Gulf
    War or in combat during a period of hostilities after 9/11.
        Regarding H.R. 3008, the ``Rural Veterans Caregiver
    Compensation Act,'' VA does support the intent of this proposed
    legislation. However, we oppose the bill because we believe it
    would duplicate some ongoing efforts by the Veterans Health
    Administration's Office of Rural Health to address the
    healthcare needs of veterans in rural areas, as well as other
    outreach activities that we are conducting for vets in those
    rural areas. And further, it would divert existing resources
    away from direct service delivery, since there is no provision
    to fund this grant program of up to $1 million per State, as I
    read the bill.
        H.R. 4274, the ``Gold Star Parents Annuity Act of 2007,''
    would provide a monthly benefit of $125 to parents of
    servicemembers who lost their lives while on active duty in
    military operations described by 10 U.S.C. section 1126(a). If
    more than one parent is eligible for the benefit, it would be
    divided equally among the eligible parents. VA honors the
    sacrifice of those who have lost their lives in the service of
    their country, and we recognize and honor the supreme sacrifice
    of Gold Star parents who have lost a son or daughter serving in
    the Armed Forces. However, we don't support the bill because we
    don't believe you can put a monetary value of this sort of a
    loss to servicemembers' life. And we already do provide a
    monthly benefit to certain qualifying parents based on need,
    our Parents Dependency and Indemnity Compensation (DIC)
    Program. Further, if parents are designated as the beneficiary
    of a deceased servicemember, then they are potentially entitled
    to DoD's death gratuity and Servicemembers Group Life
    Insurance. And these combined have the potential to add up to
    $500,000. Clearly, however, no amount of money can compensate
    for the sudden loss of a son or daughter.
        Regarding H.R. 5709, the ``Veterans Disability Fairness
    Act,'' the VA does not support this proposed legislation
    because we have already put in place measures that address most
    of the subjects covered in the bill. We are conducting quality
    reviews on a statistically valid sample of claims across ROs,
    Regional Offices. We began routinely monitoring the most
    frequently rated diagnostic codes this year, this fiscal year,
    to assess consistency of service connection determinations and
    degree of disability assigned for various disabilities across
    Regional Offices, across jurisdictions. And we conduct regular
    site visits. And locally, we pull random samples of cases that
    are adjudicated by employees responsible for deciding veterans
    claims in the administration of the local performance
    management plan.
        H.R. 5985, the ``Compensation for Combat Veterans Act,''
    would require VA to treat certain veterans as having engaged in
    combat with the enemy for purposes of 38 U.S.C. 1154(b), thus
    permitting the use of lay or other evidence for proof of
    service occurrence of a combat-related disease or injury. The
    veterans who would qualify for this treatment are veterans who
    during active service with a U.S. military, naval or air
    organization during a period of war, campaign or expedition,
    served in a combat zone for purposes of section 112 of the
    Internal Revenue Code 1986, or a predecessor provision of law.
    In essence, the bill would equate that service in a combat zone
    with the current stipulation of engaging in combat with the
    enemy.
        We don't support the bill. The current regs relax the
    evidentiary requirements a combat veteran must meet to prove
    service occurrence or aggravation, and that language makes it
    clear that its purpose is to liberalize the method of proof for
    claims based on injuries incurred or aggravated while engaged
    in combat with the enemy. This provision recognizes the unique
    circumstances of combat which are not favorable for
    documentation of injury or illness because treatment for such
    injury or illness may be administered in the field. Supporting
    evidence is often difficult to obtain when a veteran later
    files a claim for disability compensation for a combat-related
    disability, hence the provision, as we heard earlier from the
    testimony. But this bill contemplates that all veterans in a
    combat zone are faced with the same difficulty in documenting
    treatment for injury or illness. However, it doesn't appear
    that the same difficulty does exist for servicemembers who,
    although serving in a combat zone, have access to a medical
    facility for treatment and whose treatment would be documented
    in service treatment records.
        The remaining bills, H.R. 1197, and I won't read the titles
    to be expedient, but H.R. 1197, H.R. 3795, H.R. 5454, H.R.
    5954, and H.R. 6032 all propose to modify existing presumptive
    provisions that are already in place, with the exception of
    H.R. 5954, which is the presumption to exposure to biological,
    chemical, or other toxic agents as part of Project 112. That
    bill contemplates creating a new presumption for veterans who
    participated in that project.
        Beginning with the latter bill, H.R. 5954, I would like to
    begin by correcting my written statement for the record. In my
    written statement I indicated that DoD estimates about 6,000
    veterans may have been involved in Project 112/SHAD and to date
    DoD has provided VA with the names of approximately 5,000
    veterans who participated in tests. VA has actually received
    the names of 6,440 military personnel who participated in tests
    related to Project 112/SHAD. Of this number, 385 could not be
    matched to a numeric identifier such as a Social Security
    number or service number and 733 were known to have been
    deceased. We sent notification letters to all veterans that we
    were able to identify, informing them that they had been
    identified by DoD as a Project SHAD participant. And we do
    continue to work with DoD; however, we are not aware of any
    additional test participants.
        [Additional Administration views from VA for H.R. 5954
    appear on p. 121.]
        Regarding presumptives in general, in conclusion, the VA
    has a process in place to review the scientific and medical
    evidence biennially for those veterans who were potentially
    exposed to herbicides in Vietnam or hazardous agents in the
    Persian Gulf War. Further, the VA has continuously added
    additional presumptive disabilities to the list of conditions
    related to internment as prisoner of war, most recently the
    addition of atherosclerotic heart disease and stroke and its
    complications. VA is not aware of any scientific or medical
    literature or study linking diabetes mellitus and/or
    osteoporosis to POW service; however, we will look at the
    previous testimony and pull those studies to look at them.
        We are unaware of any scientific or medical evidence
    linking exposure to depleted uranium and the radiogenic
    diseases already included as diseases associated with radiation
    exposure. Nor are we aware of evidence linking any disease to
    participation in Project 112/SHAD.
        And finally, the IOM, the Institute of Medicine of the
    National Academies has consistently determined that there is
    insufficient evidence to associate Parkinson's disease with
    herbicide exposure. And ALS, again the evidence doesn't appear
    to be sufficient to establish a presumptive condition at this
    time.
        That concludes my testimony, Mr. Chairman, Ranking Member
    Lamborn, and I would be pleased to answer any questions on
    these topics.
        [The prepared statement of Mr. Mayes appears on p. 89.]
        Mr. Hall. Thank you, Mr. Mayes. For scheduling reasons I am
    going to yield to or recognize our Ranking Member, Mr. Lamborn,
    first for questions.
        Mr. Lamborn. Thank you, Mr. Chairman, for taking me out of
    order. Mr. Mayes, do veterans who cannot show a service
    connection with PTSD, but need and want treatment for PTSD,
    whatever its source might have been, do they still receive
    treatment? And could you explain what their status is?
        Mr. Mayes. Yes. Currently, veterans returning from Iraq and
    Afghanistan are entitled to receive treatment for 5 years.
        Mr. Hipolit. I believe that is correct.
        Mr. Mayes. So it is 5 years after expiration of their term
    of service. So it is comprehensive healthcare through the
    Veterans Health Administration.
        Mr. Lamborn. Okay. How would that apply, or would it apply
    to a Vietnam veteran who was in Vietnam in the sixties or
    seventies?
        Mr. Mayes. Well, I am on the benefits side. I am a little
    bit outside of my lane. So in order to be completely correct,
    that is a question I would like to take back for the record and
    provide you a more thorough response. But I will say this, I
    know that if a veteran presents, for example, to a clinic or a
    counseling center and they are in distress they are not turned
    away.
        [The following information from VA was subsequently
    received:]

            Question: What happens if a Vietnam-era veteran who has not
            filed a disability claim for PTSD came to VA seeking care for
            PTSD symptoms?

            Response: A veteran who comes to VA with a need for medical
            care would be assessed based on the nature of his or her needs
            and urgency. If the veteran needs treatment, a VA medical
            center or clinic can provide care by enrolling the veteran for
            care if he or she is in an appropriate priority group or, even
            if not, if he or she has urgent or emergent clinical needs. If
            the veteran does not meet priority requirements, the veteran
            could be referred to a Vet Center if he or she was a war zone
            veteran. If not a war zone veteran, the veteran could be
            referred to community mental health resources. Any of these
            options would lead to diagnostic assessment and possible
            service-connection for PTSD, which would then make the veteran
            eligible for VA care.

        Mr. Lamborn. Thank you. Mr. Chairman, I yield back.
        Mr. Hall. Thank you, Mr. Lamborn. Mr. Mayes, would you for
    starters just comment on some of the cases that you heard about
    today from our previous panel?
        Mr. Mayes. Okay. Well, I think one of the questions that
    was posed earlier, if my recollection serves me correctly, was
    could we service-connect a condition like Mr. Faull's condition
    if the Lou Gehrig's disease did not manifest within the current
    1-year presumptive period? And we can. What we would need,
    though, is medical evidence that would establish a link between
    the disease or the disability and military service. And really
    that is the premise of this program, of the VA's Disability
    Compensation Program, is that we have a disease or injury that
    is incurred in, or aggravated by, military service. What
    presumptives do is really they lower the threshold, the
    evidentiary threshold for certain disorders, disease processes
    where it may be difficult to get the evidence. It might be that
    we have scientific or medical evidence in the case of some of
    the other presumptives that shows a relationship between some
    exposure and military service. And therefore, we just go ahead
    and extend the presumption. But even if veterans aren't covered
    by the presumption or the relaxed evidentiary threshold, we can
    still get there, but there just has to be the nexus.
        Mr. Hall. As you heard during the questioning of the IOM,
    there were inquiries on the proposed new paradigm for
    establishing presumptions outlined in its latest report. Can
    you inform us of the VA's views on the current manner of
    establishing presumptions for disability compensation and the
    proposed system offered by the IOM in its 2007 study? What does
    VA see as its role in both systems?
        Mr. Mayes. First of all, the VA is interested in giving
    veterans their due. I want to say that up front. If there is
    evidence of causation, if there is evidence that a presumptive
    is in order, then in many cases, in the past, we have through
    regulations added presumptives to the list of disabilities that
    are subject to whatever the exposure or, for example,
    radiogenic diseases or Agent Orange.
        So we are interested in that science, and Congress has
    legislated that the Institute of Medicine will look biennially
    at the Agent Orange presumptives and the diseases possibly
    associated with Agent Orange and diseases possibly associated
    with Gulf War service. So the way that works is that the
    Institute of Medicine conducts their study, they look
    extensively at the science and literature out there, it is
    peer-reviewed, they rely on peer-reviewed research, it is my
    understanding, and then they hand that over. We have a working
    group of experts, people from the Veterans Health
    Administration, Veterans Benefits Administration, the Office of
    General Counsel who review that and the recommendations. They
    make recommendations to a task force that is comprised of the
    Under Secretaries for Health, Benefits, General Counsel, and a
    couple of other people that are on that task force. And then
    they make a recommendation to the Secretary, and ultimately he
    makes the decision. That is the way it works now.
        Mr. Hall. Okay. If I could move along.
        Mr. Hipolit. If I could just clarify, what we are looking
    for in for example, the Agent Orange or Gulf War areas, is a
    positive association between the health outcome and the
    possible exposure in service. So we don't necessarily need to
    prove causation in order to create a presumption. We will do it
    based upon a positive association, looking at the credible
    evidence for or against the association.
        Mr. Mayes. Thank you, Dick.
        Mr. Hall. Could you tell us what your position is on the
    new system that IOM proposed?
        Mr. Mayes. I am not prepared to articulate a position at
    this point. That is still being considered within VA.
        Mr. Hall. Okay. Whenever you have to the point of having a
    position, we would appreciate hearing it.
        Mr. Mayes. Absolutely, Mr. Chairman.
        [The following information from VA was subsequently
    received:]

            Question: What is VA's view on the IOM's ideas for changes in
            the process for establishment of presumptions that were
            discussed in the hearing?

            Response: The Institute of Medicine (IOM) published
            recommendations in 2008 for changes in the VA process for
            establishing presumptive disabilities. The IOM recommendations
            include creating two new advisory Committee panels. One would
            accept and review nominations for presumptive disabilities from
            veteran stakeholders. The other would be an independent
            scientific review board with the task of investigating the
            scientific basis for establishing any potential presumptive
            disability. This scientific panel would base its conclusions on
            the existence of a causal relationship between the military
            event and the subsequent disability, rather than on just an
            association between the military event and the subsequent
            disability.

            VA views these recommendations as potentially beneficial but
            there are some concerns. Of primary concern is the authority of
            the Secretary of VA to make a final determination on
            establishment of a presumptive disability. Creation of these
            panels must be for informational purposes only and must not
            interfere with the Secretary's final authority. In addition,
            this process would have to be considered in light of
            Congressional legislation already enacted that mandates
            procedures for establishing certain presumptive disabilities.
            The Agent Orange Act 1991, for example, already provides a
            process for evaluating potential herbicide related presumptive
            diseases. Any implementation of the IOM recommendations must be
            integrated with such existing law. There is also a concern that
            use of these panels may prolong the actual decisionmaking
            process and inhibit the Secretary's ability to provide the
            public with a timely response.

        Mr. Hall. And I would also like to just quickly ask you a
    couple more questions, since I am on the red light already.
    Since there is more up to date medical research on Parkinson's
    than ALS, it seems that onset does not necessarily occur in a
    year. So would section 1113(b) be the most appropriate
    provision to apply? What happens when these kinds of cases
    occur where the presumptive window has closed for the veteran
    claiming service connection for a chronic condition? Does VA
    deny chronic conditions simply because of the 1-year issue in
    section 1112?
        Mr. Mayes. No. We don't deny simply because the presumptive
    window has closed. We can't apply the presumption of service
    connection because the window has closed. But we look at the
    evidence to try and see if there is some kind of link between
    the disease and military service. For example, if a clinician
    suggested that there were symptoms that they saw in service,
    and is now attributing the disease process to those symptoms,
    that would be an avenue that we could arrive at service
    connection, even if the onset is outside of the presumptive
    window.
        Mr. Hall. It sounds to me like a legislative change to
    extend that 1-year window would make your job easier, because
    you wouldn't have to be fishing for a way to get around it in
    the case of a disease where frequently, if not most of the
    time, the disease is not actually diagnosed or doesn't reach a
    point where you can definitively say what it is until after the
    1 year has passed.
        Mr. Mayes. Yes. It would be easier. The evidentiary----
        Mr. Hall. You could spend your time getting the treatment
    rolling and moving on to another case instead of going and
    trying to get around the 1 year and find a way to get the
    person covered.
        Mr. Mayes. Of course we have a mandate to ensure that we
    are compensating for diseases or disabilities due to service.
        Mr. Hall. Right. And we are trying to help you do that. I
    appreciate that you want that, and that we are all after the
    same thing here.
        Does VA track the number of claims it has gotten from
    veterans with Parkinson's, ALS, or those exposed to DU or
    Project 112?
        Mr. Mayes. Well, yes. The claims from Project 112, yes, we
    do have those numbers. I don't know if I have those with me. We
    know how many letters we sent out to veterans. In fact, I do
    have that. But it was between 4,000 and 4,500. So it wasn't the
    full amount because we couldn't necessarily definitively
    identify the name that was handed us from DoD or we couldn't
    get an address.
        [The following information from VA was subsequently
    received:]

            Question: Does VA track claims for Parkinson's, ALS, Depleted
            Uranium-connected, and Project SHAD-connected claims? If so,
            please provide demographic information on these populations.

            Response: VA tracks the number of claims filed in certain
            categories and other relevant information in recurring reports.
            However, we do not capture demographic information. Available
            information is provided below on the requested claim
            categories.

                    1.  Parkinson's disease

                            As of May 2008, VA identified 968 veterans
                            currently receiving compensation for
                            Parkinson's disease. The following table
                            provides the breakdown by the combined
                            evaluation:

    ------------------------------------------------------------------------
                  Comb Evaluation                          Veterans
    ------------------------------------------------------------------------
     10%                                                                 26
    ------------------------------------------------------------------------
     20%                                                                 18
    ------------------------------------------------------------------------
     30%                                                                 82
    ------------------------------------------------------------------------
     40%                                                                 78
    ------------------------------------------------------------------------
     50%                                                                 67
    ------------------------------------------------------------------------
     60%                                                                 77
    ------------------------------------------------------------------------
     70%                                                                115
    ------------------------------------------------------------------------
     80%                                                                124
    ------------------------------------------------------------------------
     90%                                                                 93
    ------------------------------------------------------------------------
    100%                                                                288
    ------------------------------------------------------------------------
    Total                                                               968
    ------------------------------------------------------------------------

                    2. Amyotrophic Lateral Sclerosis (ALS)

                            As of September 2008, VA has identified 871
                            unique veterans who have submitted a claim for
                            ALS. The following table provides the
                            breakdowns by year and decision.

    ------------------------------------------------------------------------
                    Fiscal Year                        Unique Veterans
    ------------------------------------------------------------------------
    FY 2004                                                             133
    ------------------------------------------------------------------------
    FY 2005                                                             184
    ------------------------------------------------------------------------
    FY 2006                                                             148
    ------------------------------------------------------------------------
    FY 2007                                                             183
    ------------------------------------------------------------------------
    FY 2008                                                             227
    ------------------------------------------------------------------------

            3. Depleted uranium

                    VA does not specifically identify claims for depleted
                    uranium.

            4. Project SHAD

                    As of September 2008, VA has received 679 Project 112/
                    SHAD claims; 65 are pending and 614 have been decided.

        Mr. Hall. Right. Maybe you could provide us after the fact
    additional information on these populations, such as
    demographic descriptions and how many have sought treatment. I
    wanted to ask you the current backlog stands, as I understand
    it, is at about 650,000 cases, claims that are waiting to be
    adjudicated. How many of these are for veterans who have been
    diagnosed with PTSD but lack a verified stressor? And that may
    be something you have to get back to us on, too, but I just
    wanted to ask you that question.
        Mr. Mayes. I don't know how many claims are pending right
    now today for PTSD. I do know the number of veterans who are on
    the rolls right now for PTSD. And that is 328--as of the end of
    May it was 328,923. And that compared to 1999 of only 122,070.
    So we know we are service connecting post traumatic stress
    disorder.
        [The following information from VA was subsequently
    received:]

            Question: How many PTSD claims are pending where there is no
            verified stressor?

            Response: PTSD claims may be pending for several reasons. VA
            does not record the number of claims pending where the stressor
            has not been verified. Claims are generally pending because
            development is being undertaken and evidence gathered.

        Mr. Hall. That is probably a good thing.
        Mr. Mayes. We think so.
        Mr. Hall. Not a good thing they have PTSD.
        Mr. Mayes. Yes, Mr. Chairman.
        Mr. Hall. But a good thing if they have it as a result of
    their service that they be treated and classified.
        So in light of the issues we have been discussing regarding
    chemical exposures, the Veterans Disability Benefits Commission
    (VDBC) recommended that VA create a health registry for
    veterans who served at Fort McClellan and were potentially
    exposed to PCBs and other chemicals. What are your thoughts on
    these findings? What has VA done so far to implement this
    recommendation?
        Mr. Mayes. I think that is one I would like to take for the
    record as well, because I believe it would likely be the
    Veterans Health Administration that would create the health
    registry and maintain it. So I can take that, and if you will
    indulge me, get back with you.
        [The following information from VA was subsequently
    received:]

            Question: What is VA's opinion on the recommendation of the
            October 2007 Veterans' Disability Benefits Commission report
            that VA initiate a registry and take other action with regards
            to possible PCB exposure at Fort McClellan, Alabama?

            Response: While VA appreciates the recommendations and work of
            the Veterans' Disability Benefits Commission, VA does not
            support the creation of such a registry. Creating one is
            unlikely to improve the health or otherwise benefit those
            veterans who may have been stationed at a U.S. military base
            that also had hazardous materials onsite.

            VA often hears from individuals and groups of veterans who are
            concerned about how their health may have been affected by
            exposure to environmental hazards at the U.S. military bases
            where they were stationed. The military uses many common
            hazardous materials at bases across the country. The U.S.
            Environmental Protection Agency (EPA) tracks nearly 1,600
            hazardous waste sites across the country, and more than 170 of
            these are current or past military bases, including Ft.
            McClellan.

            Moreover, a recent Department of Defense (DoD) evaluation
            concluded that there is little or no PCB contamination
            specifically at Fort McClellan that could have led to exposure
            of Army personnel.

            However, Army personnel living off-base in the nearby town of
            Anniston may have been exposed to PCBs located there. That is
            why current scientific studies by the U.S. Department of Health
            and Human Services (HHS) on the health of Anniston residents,
            which include any veterans who may reside there today, are so
            important. HHS scientists are currently conducting four studies
            that evaluate PCB health effects for Anniston residents,
            including neurological health, PCB blood levels, health status
            of exposed children and adults, reproductive health issues, and
            environmental PCB levels. VA closely monitors these studies,
            particularly as they may turn out to relate to the health of
            servicemembers who may have been stationed at Fort McClellan.
            However, until they are completed, we have little or no data
            that would indicate any health problems from PCB exposure
            related to military service in or around Anniston.

            In addition, it would be difficult to conduct meaningful health
            studies of veterans formerly stationed at Fort McClellan, even
            if it were possible to establish records of who served there
            during the relevant period. This is because of the difficulties
            of identifying and locating personnel who served in the
            relevant time period, finding accurate information about their
            actual exposures, obtaining older military medical records, and
            establishing a reasonable ``control'' or comparison group.
            Therefore, the ongoing HHS study provides the greatest chance
            of identifying a health risk from an environmental exposure.

            Fortunately, veterans enrolled for VA healthcare with health
            problems related to PCB exposure while on active duty do not
            have to wait for such a study to seek healthcare and disability
            compensation from VA. The long-term health consequences of
            exposure to PCBs are very well documented. If any veteran has
            an illness related to PCB exposure and they can provide
            evidence that they were exposed during military service, they
            would have a good case for a related disability claim.

            Fact Sheet

            Polychlorinated biphenyls (PCBs) have been identified in at
            least 500 of the 1,598 hazardous waste sites that have been
            proposed for inclusion on the EPA National Priorities List
            (Agency for Toxic Substances and Disease Registry, U.S.
            Department of Health and Human Services, Toxicological Profile
            for Polychlorinated Biphenyls (PCBs), November 2000,
            www.atsdr.cdc.gov/toxprofiles/tp17.html).

            An analysis of the hazardous waste sites listed by HHS Agency
            for Toxic Substances and Disease Registry (ATSDR) indicates
            that 173 sites are current or past military sites, where
            military personnel could have been exposed to hazardous
            substances. One of these 173 sites was Ft. McClellan.

            A recent report from DoD's U.S. Army Center for Health
            Promotion and Preventive Medicine Information Paper, MCHB-TS-
            RAO, 13 July 2006, ``Polychlorinated Biphenyls (PCB)
            Environmental Contamination Sources at Ft. McClellan, Alabama
            and Surrounding Areas'') concluded that ``there is little or no
            environmental contamination at Ft. McClellan that may have
            exposed Army personnel at Ft. McClellan to PCBs.'' However,
            they also pointed out that ``Army personnel who have previously
            resided or currently reside within the identified contaminated
            areas in [the town of] Anniston may have been exposed to
            concentrations above EPA action levels and suffer an elevated
            health risk equivalent to the local non-Army population.'' That
            is why the current ongoing HHS study on the health of Anniston
            residents is particularly relevant.

            The U.S. Department of Health and Human Services, Agency for
            Toxic Substances and Disease Registry (ATSDR) has a series of
            four studies now underway at Anniston, and VA has been
            regularly in contact with the investigators for this study to
            monitor its progress and results.

            The first is looking at neurological health among adolescents
            at Anniston, along with measuring blood levels of lead and
            PCBs. The study is also checking the health status and exposure
            of their parents.

            The second study is looking at the health of 1,200 adults for
            all health outcomes, with a particular focus on type 2
            diabetes, as well as PCB blood levels.

            The third study is looking at reproductive health issues among
            women and children in Anniston.

            The fourth study is monitoring for PCBs in the environment, a
            sort of ``geo-environmental'' analysis, with a focus on
            schools, etc.

        Mr. Hall. That would be wonderful. Thank you.
        Last year IOM recommended that VA improve the quality of
    the claims adjudication process and improve its accuracy. As we
    heard from IOM, accuracy was 88 percent in 2006. Do you know
    what it is now? And what is the target?
        Mr. Mayes. Well, I believe the 88 percent number referred
    to the rating accuracies. So that would be the entitlement
    determinations. And I believe we are still at 88 percent.
        Mr. Hall. Okay. Do you have a target?
        Mr. Mayes. Yes, sir, we do. I believe it is 92 percent. The
    target is 92 percent. Now, I might add that we--Congress has
    been generous, and we have been able to hire over 3,000
    employees. And so what we see happening is we have an influx of
    new employees into the work force. And we are trying to get
    them up to speed, but their decisions are considered just as
    well as those decisions made by journey level decisionmakers.
    So it is, I believe, having some impact.
        Mr. Hall. Well, you are welcome.
        Mr. Mayes. Thank you.
        Mr. Hall. And we want to help, as you can tell.
        Last, I wanted to say and ask, you mentioned the VDBC
    report and the Center for Naval Analysis (CNA) analysis on
    training, which was complimentary in comparison with other
    Federal agencies. However, you did not address the Commission's
    concerns with the emphasis on production over training, which
    is complicated by the turnover rate and the inexperience of
    raters. How is the VBA addressing these issues?
        Mr. Mayes. Well, we frequently hear this. Brad Flohr and I
    both have been employees in the field. When you have veterans
    like we heard from today who have claims that are pending and
    you know they are behind you waiting for a decision, you want
    to push those through. I mean our employees don't like having
    this backlog. So there is a press to move the work. What I can
    say is that we manage individual performance by holding our
    employees accountable. We have a standard. And that standard
    includes both production and quality. So we do, on an
    individual basis at the RO, sampling. We pull cases, we review
    for quality. And an individual employee can be terminated,
    worst case scenario can be terminated for poor quality just as
    well as they can be for lack of production. So they have to do
    both, and they want to do both.
        Mr. Hall. Good. Well, thank you very much. I would like to
    turn to my new Ranking Member, Mr. Bilirakis, for his
    questions. Mr. Bilirakis.
        Mr. Bilirakis. Thank you. Thank you, Mr. Chairman. I
    appreciate it. Director Mayes, in your written testimony you
    state that the VA does not support H.R. 1197 because of the
    timeline for the VA to make determinations and publish
    regulations for establishing procedures for determining future
    presumptions for POWs. You said that it was untenable. You also
    stated the VA is not aware of any credible scientific
    literature to show an association between the medical
    conditions covered in H.R. 1197 and POW internment.
        I was surprised by the VA's opposition to my legislation
    because the VA's previous testimony on H.R. 348 supported the
    bill. And my staff will give you the VA's previous testimony.
    In 2004, the VA testified, and I quote here, ``it strongly
    supports enactment of section 2(c) of H.R. 348, providing that
    Congress can find offsetting savings. No one can reasonably
    doubt that the stresses and privations endured by prisoners of
    war take heavy tolls on their health in ways that may never be
    fully understood. The majority of POWs, are aging veterans of
    World War II who are unable to wait for science to provide
    definitive answers. Moreover, former POWs as a group do not
    benefit from relatively relaxed statutory standards, such as
    the positive association standard applied in the case of all
    Vietnam veterans because of their potential for exposure to
    defoliants used there. So for weighing the scientific evidence
    regarding associations between their service experience and
    later occurring diseases. There is some scientific evidence
    suggesting an association between the POW experience and each
    of the illnesses covered by the bill, which is 348 in 2004. And
    because these veterans are particularly deserving of special
    consideration, they too should be afforded the benefit of the
    doubt''.
        Since my bill is virtually identical to H.R. 348, why is
    the VA now opposing this language? And what has occurred to
    justify the change in position? That is my first question.
        Mr. Mayes. The testimony that we submitted cited the
    reasons for the opposition. I do not know what the rationale
    was back in 2004. I know that was about the time I think that
    we actually added stroke and atherosclerotic heart disease. It
    might have been 2005. But I am going to go back and look, and I
    can provide you a more definitive answer.
        Mr. Bilirakis. Okay. Can you please get back to me?
        Mr. Mayes. Yes, sir. We will do that. We will reconcile
    those differences.
        [The following information from VA was subsequently
    received:]

            Question: Please explain why VA supported H.R. 348 in 2004 yet
            opposed a very similar bill (H.R. 1197) today. Why are the
            costs estimated by VA so much higher for H.R. 1197 than the
            previous bill?

            Response: VA did support the addition of cardiovascular disease
            and stroke to the presumptive list for former POWs (FPOWs) in
            H.R. 348 and those conditions were subsequently added by
            amendment to statute and regulations. VA also did not oppose
            the addition of the other diseases mentioned in H.R. 348
            although there was no strong evidence identified that would
            support an association between the POW experience and
            subsequent disease development.

            H.R. 1197, however, would eliminate the requirement of any
            minimum internment periods. A veteran who was held 1 day or
            even a few hours could be service-connected for diseases that
            are generally associated with nutritional deficiencies
            associated with extreme deprivation. Additionally, VA remains
            unaware of any peer-reviewed studies that associate FPOW
            experiences with the subsequent development of Type II diabetes
            mellitus. Therefore, we do not support the addition of this
            condition to the presumptive list. Subsequent to our testimony
            on this legislation, however, the Secretary has become aware of
            studies that provide a basis for determining that an
            association exists between FPOWs who were held in captivity for
            30 days or more and the subsequent development of osteoporosis.
            VA has drafted regulations to add this condition to the list of
            recognized presumptive conditions.

            In estimating the cost for H.R. 1197, VA applied prevalence
            rates for osteoporosis and diabetes to more precisely identify
            the population of veterans and survivors that would apply for
            and be granted benefits. As a result, the population changed
            significantly from the earlier estimate. Additionally, the
            impact of the presumptions for POWs was revised. When providing
            a cost estimate for the earlier bill, we assumed the average
            service-connected disability payment was at the 30 percent
            level, resulting in a combined 50 percent disability rating.
            Currently the average disability payment for FPOWs is estimated
            to be at the 40 percent level, which we anticipate would raise
            the combined evaluation to 60 percent. In terms of monthly
            disability compensation benefit payments, a disability payment
            for the 50 percent combined evaluation 4 years ago was $646,
            while a monthly disability payment for a 60 percent combined
            evaluation currently is $921. The survivors benefit amount has
            also increased from $967 to $1091.

        Mr. Bilirakis. Okay. And then in 2004 the VA estimated that
    H.R. 348, on the same subject, would cost approximately $589
    million over 10 years. H.R. 348 would have established
    presumptions for five conditions, heart disease, stroke, liver
    disease, Type 2 diabetes, and osteoporosis. The VA is now
    submitting that H.R. 1197, which establishes presumptions for
    only two conditions, Type 2 diabetes and osteoporosis, will
    cost almost $800 million over 10 years. Although I realize it
    has been over 4 years since the VA's last estimate, I am
    puzzled by this. As I said, our bill only covers the two
    presumptions. So if you can get back to me on that I would
    appreciate it as well.
        Thank you very much. Thank you, Mr. Chairman.
        Mr. Hall. Thank you, Mr. Bilirakis. And we thank you for
    your patience, Mr. Mayes, Director Mayes, Mr. Flohr and Mr.
    Hipolit. Thank you for being here and for your testimony. We
    look forward to receiving the written responses that we have
    asked for. Thank you for your insight and opinions. And this
    hearing stands adjourned.
        [Whereupon, at 5:16 p.m., the Subcommittee was adjourned.]

                                A P P E N D I X

                                  ----------

               Prepared Statement of Hon. John J. Hall, Chairman,
           Subcommittee on Disability Assistance and Memorial Affairs

        Good Afternoon.
        The Veterans' Affairs Disability Assistance and Memorial Affairs
    Subcommittee Legislative Hearing will now come to order.
        I would ask everyone to rise for the Pledge of Allegiance--flags
    are located in the front of the room.
        I would first like to thank the witnesses for coming today to
    appear before the Disability Assistance and Memorial Affairs'
    Subcommittee for our fifth legislative hearing. Today we will examine
    11 bills which I will identify by bill number for the sake of brevity:
    H.R. 1197, H.R. 3008, H.R. 3795, H.R. 4274, H.R. 5155, H.R. 5448, H.R.
    5454, H.R. 5709, H.R. 5954, H.R. 5985 and H.R. 6032.
        As a preliminary, I ask unanimous consent that Mr. Filner, Mr.
    Brown and Mr. Space be invited to sit on the dais for today's hearing.
    Without objection, so ordered.
        I know the issues addressed in these bills are of utmost importance
    to many of you in attendance today, who like me, have constituents or
    loved ones who are directly impacted by the problems they seek to
    solve.
        The subjects of the bills range from establishing presumptions of
    service-connection for certain diseases to loan forgiveness for
    veterans who die in combat. I look forward to hearing the informed
    testimony of our invited witnesses today.
        Speaking of invited witnesses, I must express my disappointment
    that the DoD did not find it ``efficient'' to provide a witness to
    testify, particularly on legislation that has clear DoD implications.
    Moreover, this notice came late last week after testimony was due and
    after the DoD originally indicated that it intended to provide a
    witness. I hope to avoid this unnecessary wrangling in the future. Our
    veterans should be important to every implicated Federal agency. The
    nexus between the DoD and VA are undeniable and should not be rebuffed
    by the DoD when we are attempting to examine issues that overlap on
    jurisdiction and responsibility.
        I note that yesterday the DoD did provide a written statement for
    the record. This fact aside, this Congress deserves the right to
    question the appropriate DoD personnel in person, not just in writing.
    Not to mention that our men and women who have given their all in
    service to our country deserve the right to have their elected
    representatives question the executive branch. This is how our system
    of checks and balances must work to ensure our democratic way of
    governing remains intact.
        As I know that many of you in attendance are eager to ask questions
    of, or to hear answers from our knowledgeable witnesses, I will reserve
    the rest of my time for questioning. Since we have eleven bills under
    consideration today, I'll let everyone know how I intend to proceed.
    After Mr. Lamborn gives his opening statement, I will recognize Members
    of the Committee who have legislation pending before the Subcommittee
    today. I ask that other Members of the Subcommittee that do not have
    legislation pending to please submit your statements for the record.
        We will then proceed to Panel I to receive testimony from our
    colleagues who have sponsored legislation pending before the DAMA
    Subcommittee. We will then proceed to panels II, III and IV each to
    follow by a round of questions where each Member on the dais will be
    offered 5 minutes to ask questions of the witnesses on that panel, in
    order according to the Rules of the House.
        I now recognize Ranking Member Lamborn for his Opening Statement.

      Prepared Statement of Hon. Doug Lamborn, Ranking Republican Member,
           Subcommittee on Disability Assistance and Memorial Affairs

        Thank you Mr. Chairman for yielding and I thank you and your staff
    for holding this hearing today.
        This afternoon, we are considering several pieces of legislation,
    all of which are of interest and potential value.
        While I do have some policy concerns regarding a number of the
    provisions, I am primarily struck by the mandatory offsets that would
    be necessary to pass many of these bills under PAYGO rules.
        Mr. Chairman as you know from the PAYGO problems with H.R. 5892, it
    is always a challenge to find offsets within our jurisdiction and that
    is something we need to keep in mind as we examine these bills today.
        The main policy concern I wish to express is that some of the
    provisions before us are similar to section 101 of H.R. 5892, in that
    they would redefine combat with the enemy as it pertains to section
    1154 of title 38.
        Mr. Chairman, my concerns with these types of provisions are not
    new to you or other Members of the Committee and I will not reiterate
    them here, except to point out that a loose definition of combat would
    diminish the immeasurable sacrifice and service of those who actually
    did face combat.
        While I understand and appreciate the effort to address problems
    regarding the VA claims backlog, I believe that they generally result
    from procedural issues and we should address the problems accordingly.
        On another note, I look forward to the testimony of the
    representatives from the Institute of Medicine who will hopefully
    enlighten the Subcommittee about the process involved in establishing a
    presumption of service-connection for certain illnesses and
    disabilities.
        Experts at VA and IOM have years of experience in dealing with
    these issues, and I think it is important for Congress to avail itself
    to their expertise whenever possible.
        Mr. Chairman I extend my thanks to you and your staff for holding
    this hearing and I look forward to hearing the testimony of our
    colleagues and the other witnesses today. I yield back.

                  Prepared Statement of Hon. Michael Thompson,
           a Representative in Congress from the State of California

        Thank you, Chairman Hall and Ranking Member Lamborn, for holding
    this hearing. I introduced H.R. 5954 along with Congressman Denny
    Rehberg to allow veterans who were unknowingly used as guinea pigs in
    chemical and biological tests by their own government to seek medical
    care and compensation for their resulting illnesses. These tests--known
    as Project 112, which included Project SHAD, exposed at least 6,000
    servicemembers without their knowledge to extremely harmful chemical
    and biological weapons--and we believe there are many more veterans out
    there that don't even know they were exposed. However, the Department
    of Veterans Affairs routinely rejects their claims for medical care and
    compensation. Our legislation will finally correct this injustice and
    get these men treatment they earned by honorably serving their country.
        I am honored that my constituent and former tug boat commander Jack
    Alderson is here to testify today and share his first-hand knowledge of
    Project SHAD with you. Jack has been a tireless advocate for the
    veterans who were subjected to these tests and has kept in touch with
    many of them.
        When I first questioned the Department of Defense (DoD) in late
    1999, they told me that Project SHAD did not exist. Then I was told
    that the tests existed, but only simulants were used. Finally, after 3
    years of investigating, the DoD finally revealed that these tests
    involved live agents, in some cases Vx and Sarin nerve gases and E.
    Coli, along with a whole host of other substances known to cause
    extreme illness in humans. But despite these shocking revelations, the
    DoD has without reason stopped looking for records of Project 112
    service personnel and notifying the veterans subjected to these tests.
    The VA still does not recognize any long-term health consequences from
    exposure to these agents. As Jack Alderson will testify today, members
    of his crew and other affected servicemembers have since developed
    abnormal cancers and acute respiratory issues but are routinely
    rejected by the VA.
        You will also hear today from Dr. Judith Salerno, Executive
    Director of the Institute of Medicine. In 2002, Congress directed and
    appropriated $3 million for the IOM to conduct a study of the health
    effects associated with the chemicals used during Project SHAD. Dr.
    Salerno will tell you that after 5 years of research, the IOM found no
    connection between the substances tested and the health problems of the
    SHAD veterans. With all due respect to IOM, I strongly believe their
    findings to be unsound. During the briefing on the IOM report, and
    utilizing the expertise of SHAD veterans Jack Alderson and John Olson,
    Congressman Rehberg and I identified serious deficiencies in the
    protocol used by IOM. For example, the health records of deceased
    Project SHAD veterans, who may have died as a result of health effects
    stemming from exposure during Project SHAD, were not examined. Such an
    omission could have a large impact on the results of the study. I
    hereby enter into the hearing record the letter sent to Dr. Rick
    Erdtmann of the IOM, which further outlines these issues and requests
    that the study be reopened. It is my understanding from the IOM that
    their review is ongoing and I look forward to hearing their results.
    But in the meantime, I want to also enter into the record a
    bibliography of fact sheet after fact sheet that have been prepared by
    other agencies and departments within U.S. Government that say exposure
    to these substances do in fact have long-term health consequences.
        It is incumbent upon Congress to ensure that any servicemember who
    participated in these tests is provided with treatment if they have
    health problems associated with these tests. We can not wait any
    longer, considering many of these brave men who served their country
    are now sick or have even passed away. Project 112 and similar cases of
    chemical and biological testing on servicemembers is an issue of trust
    and integrity. How can we expect the current generation of soldiers to
    put their lives on the line knowing that harm from the enemy may not be
    the only danger they encounter? Jack and other crewmembers are
    beginning or have already experienced health problems that may be
    associated with these tests, and every day that we wait, I fear that
    these brave veterans grow sicker. Thank you for your time and
    consideration of this very important bill. It is imperative for us to
    right our government's past wrongs and help these brave veterans who
    unknowingly participated in these tests.

                                     ______

                                          Congress of the United States
                                          U.S. House of Representatives
                                                        Washington, DC.
                                                      February 15, 2008

    Dr. Rick Erdtmann, Director
    Board on Military and Veterans Health
    Medical Followup Agency
    Institute of Medicine of the National Academies
    500 Fifth Street, N.W.
    Washington, D.C. 20001

    RE:  Institute of Medicine (IOM) Study Long-Term Health Effects of
    Participation in Project SHAD

    Dear Dr. Erdtmann:

        In November 2007, you and Dr. Bill Page briefed us on the results
    of the June 2007 IOM study that had been requested by the Congress. The
    study looked at the long term health effects on veterans exposed during
    the operation of Project SHAD (Shipboard Hazard and Defense). As you
    know, the study failed to link Project SHAD to health problems
    experienced by veterans exposed during the testing project. During our
    briefing, and utilizing the expertise of SHAD veterans Jack Alderson
    and John Olson, we identified what we believe to be deficiencies in the
    protocol and requested that IOM reopen the study. This letter outlines
    the principal concerns we discussed and represents a formal request to
    reopen the IOM study.

        1.  The study acknowledges that ``up to five Army light'' tug boats
    participated in ``several'' Project SHAD tests, but it claims that
    complete personnel rosters were never found by the Department of
    Defense (DoD) or by IOM. According to SHAD veterans, the rosters were
    provided. For instance, a roster of personnel involved in the 1965
    Shady Grove test, approximately 106 participants, was provided to IOM
    and confirmed by DoD. With the rosters identified and made available,
    we would expect the personnel to be considered in the study.

        2.  Personnel that were not exposed during Project SHAD were
    included in the study: a) the USS Granville S Hall (YAG 40), the Desert
    Test Center Command and Laboratory ship, was not exposed during Project
    SHAD; b) the USS George Eastman (YAG 39), participated only in some
    Project SHAD tests and not in others. We believe the inclusion of
    personnel from these two ships compromises the study results. We
    request that IOM examine how the inclusion of sterile personnel may
    have affected the results.

        3.  The health records of deceased Project SHAD Technical Staff,
    who may have died as a result of health effects stemming from exposure
    to Project SHAD, were not examined. We would like you to determine if
    the cause of death information for those individuals is available and
    measure what impact that information would have on the results of the
    study.

        4.  The study failed to account for the job and duty assignments of
    various personnel on board the ships, which resulted in different
    levels of exposure. Consideration should be given to the fact that
    personnel had different levels of exposure during training and testing
    to multiple weapons, experimental vaccines, trace elements, simulants,
    and decontamination agents. These considerations should be factored in
    to gain the most accurate results.

        5.  The description of the tests performed does not reflect the way
    in which the SHAD test was actually conducted. SHAD veterans must be
    consulted to ensure that any existing misconceptions in the IOM study
    are rectified.

        Finally, the IOM study delineated a number of conclusions that were
    reached after classified material was reviewed by you and Mr. Don
    Burke. (See the IOM Study, p. 8-9.) SHAD veterans contest some of these
    conclusions, such as the conclusion regarding animal studies, as well
    as the one regarding vaccines. We request that these specific concerns
    be discussed more fully at the working group agreed to at the meeting,
    which will include representatives from DoD, IOM, selected SHAD
    veterans, and our staff.
        We appreciate the briefing you provided and your willingness to
    review the items described above. By this letter, we formally request
    that IOM initiate the necessary steps to reopen the IOM study, and to
    work with DoD, as well as Project SHAD veterans, to address the above-
    referenced concerns. If you have additional questions, please contact
    our staff, Tracy Varghese at (202) 226-7372 or Brent Mead at (202) 225-
    3211.

                Sincerely,

        Mike Thompson
        Member of Congress
                                                 Dennis Rehberg
                                             Member of Congress

                                    ------

    Bibliography of Facts Sheets of Chemical and Biological Agents used in
                                  Project SHAD
        ``Health Effects of Project SHAD Biological Agent: Bacillus
    Globigii,'' The National Academies, 2004, Contract No. IOM-2794-04-001.
        ``Health Effects of Project SHAD Chemical Agent: Betapropiolactone
    [CAS #57-57-8],'' The National Academies, 2004, Contract No. IOM-2794-
    04-001.
        ``Health Effects of Project SHAD Biological Agent Coxiella Bumetii
    [Q-Fever],'' The National Academies, 2004, Contract No. IOM-2794-04-
    001.
        ``Calcium Hypochlorite, CAS #7778-54-3; Sodium Hypochlorite, CAS
    #7681-52-9,'' Fact Sheet prepared by Agency for Toxic Substances and
    Disease Registry, U.S. Department of Health and Human Services, Public
    Health Service, April 2002.
        ``Calcium Hypochlorite (CaCl202)/Sodium Hypochlorite, (NaOCI), CAS
    7778-54-3/7861-52-9; UN 1748/1791,'' Agency for Toxic Substances and
    Disease Registry, U.S. Department of Health and Human Services.
        ``Di(2-ethylhexyl) phthalate (DEHP), CAS #117-81-7,'' Fact Sheet
    prepared by Agency for Toxic Substances and Disease Registry, U.S.
    Department of Health and Human Services, Public Health Service,
    September 2002.
        ``Concise International Chemical Assessment Document 52: Diethyl
    Phthalate,'' World Health Organization, Geneva, 2003.
        ``Chemical Information Profile for Diethyl Phthalate [CAS No. 84-
    66-2]: Supporting Nomination for Toxicological Evaluation by the
    National Toxicology Program,'' National Institute of Environmental
    Health Sciences, National Institutes of Health, U.S. Department of
    Health and Human Services, November 2006.
        ``Diethyl Phthalate, CAS #84-66-2,'' Fact Sheet prepared by Agency
    for Toxic Substances and Disease Registry, U.S. Department of Health
    and Human Services, Public Health Service, September 1996.
        ``Bis(2-ethylhexyl) Phosphate, CAS No. 298-07-7,'' International
    Programme on Chemical Safety, October 2001.
        ``Escherichia coli,'' Centers for Disease Control, Department of
    Health and Human Services, March 27, 2008.
        ``Ethylene Oxide, CAS #75-21-8,'' Fact Sheet prepared by Agency for
    Toxic Substances and Disease Registry, U.S. Department of Health and
    Human Services, Public Health Service, July 1999.
        ``Formaldehyde, CAS #50-00-0,'' Fact Sheet prepared by Agency for
    Toxic Substances and Disease Registry, U.S. Department of Health and
    Human Services, Public Health Service, June 1999.
        ``Health Effects of Project SHAD Chemical Agent: Methyl
    Acetoacetate, CASD #105-45-3,'' The National Academies, Spring 2004,
    Contract No. IOM-2794-04-001.
        ``Health Effects of Project SHAD Biological Agent: Pasteurella
    [Francisella] Tularensis [Tularemia],'' The National Academies, Spring
    2004, Contract No. IOM-2794-04-001.
        ``Health Effects of Project SHAD Chemical Agent: Phosphorus-32
    [Radiotoxic Effects],'' The National Academies, Spring 2004, Contract
    No. IOM-2794-04-001.
        ``Q-Fever,'' Centers for Disease Control, Department of Health and
    Human Services, February 13, 2003.
        ``Health Effects of Project SHAD Biological Agent: Serratia
    Marcescens,'' The National Academies, 2004, Contract No. IOM-2794-04-
    001.
        ``FDA Warns Public of Contaminated Syringes,'' Press Release, U.S.
    Food and Drug Administration, January 25, 2008.
        ``Staphylococcal Food Poisoning,'' Centers for Disease Control,
    Department of Health and Human Services, March 29, 2006.
        ``Sulfur Dioxide, CAS #7446-09-5,'' Fact Sheet prepared by Agency
    for Toxic Substances and Disease Registry, U.S. Department of Health
    and Human Services, Public Health Service, June 1999.
        ``Tularemia,'' Centers for Disease Control, Department of Health
    and Human Services, October 7, 2003.
        ``Toxicologic Assessment of the Army's Zinc Cadmium Sulfide
    Dispersion Tests: Free Executive Summary,'' National Academy of
    Sciences, 1997.

                  Prepared Statement of Hon. Denny R. Rehberg,
             a Representative in Congress from the State of Montana

        H.R. 5954--To grant presumption of service connection to veterans
    of Project 112, including Project SHAD.
        Thank you Mr. Chairman and Members of the Subcommittee for allowing
    me to testify today on my legislation, H.R. 5954, to grant presumption
    of service connection to veterans of Project 112, including Project
    SHAD.
        I would also like to thank Representative Mike Thompson, who has
    been a tireless advocate on this issue. It has been my pleasure to work
    with him to bring these tests to light and fight to get Project 112/
    SHAD veterans the benefits they deserve.
        When I was first elected to the House of Representatives in 2001, I
    was approached by Billings resident John Olsen. John told me a
    disturbing tale of a government refusing to be accountable for its
    actions, a long line of healthcare problems, and a lack of care.
        In the early Cold war era, the Department of Defense and other
    Federal agencies conducted a series of tests called Project 112. During
    these projects, a number of weapons containing chemical and biological
    agents such as VX nerve gas, Sarin Nerve Gas and E. Coli were tested on
    unknowing military personnel. John is one of the victims. Over the
    years, he has battled several health problems including skin cancer,
    prostate cancer, and an adrenal tumor the size of his fist.
        Even worse, for more than 40 years the existence of these tests was
    denied by the Department of Defense (DoD), despite reports from
    participating veterans, like John, that they were being stricken with
    unusual diseases. During that time, many of these veterans suffered and
    died while their government looked the other way. Finally, in 2001, the
    DoD acknowledged that the tests took place. However, the Veterans
    Administration (VA) still wouldn't provide these veterans with health
    benefits and compensation for their diseases.
        Instead, the VA commissioned a study which was conducted by the
    Institute of Medicine. Representative Thompson and I have questioned
    the validity of this study as it relates to the long term health
    effects on veterans of Project SHAD. Without going into too much
    detail, the study did not accurately portray the method in which these
    tests were conducted, and did not include sailors from the light tug
    boats participating in the tests and which my constituent John Olson
    served on. This was a deeply flawed study that should not be used as a
    basis to deny benefits to these veterans.
        While working on this issue, I've been alarmed by the deficiency of
    the program for notifying Project SHAD veterans of their exposure. Due
    to pressure from Congress, initial search efforts began in 2000;
    however, they were and continue to be inadequate bordering on
    negligent.
        Since 2003, the Department of Defense has stopped actively
    searching for individuals who were potentially exposed to chemical or
    biological substances during Project 112/SHAD. At that time, the
    Department of Defense reported it had identified 5,842 servicemen and
    estimated another 350 civilians were exposed during these tests.
        Since the 2003 report to Congress an additional 598 veterans of
    these tests have been identified as potentially exposed. 394 were found
    in the June 2007 Institute of Medicine study, 165 were provided by
    various veterans' advocacy organizations, and another 39 were found
    through the Government Accountability Office's efforts. All told, since
    the Department of Defense stopped looking, 598 veterans have been
    identified, 10 percent of the original total. Put simply, we do not
    know how many more veterans may be out there.
        It is a true tragedy that our government, after exposing these
    servicemen and women to a witch's brew of chemicals, cannot be bothered
    to find and notify them of such.
        As I mentioned earlier, the Department of Defense did identify
    around 350 civilians who were potentially exposed during the course of
    these tests. However, to date, no effort has ever been made to notify
    these civilians.
        H.R. 5954, in addition to the well-deserved presumption of service
    connection designation, would begin to draw a circle around the problem
    and correct it by implementing the recommendation from a February 2008
    GAO report on Project SHAD. The Department of Defense must reopen its
    search and notification efforts, or provide an adequate cost-benefit
    analysis as to why not.
        This legislation will help set a standard of oversight for the
    Federal Government's treatment of our soldiers. We can't sweep the
    suffering of these veterans under the rug. We can fix the problem
    created 40 years ago, and this legislation will do that.
        Again, thank you for allowing me the opportunity to testify. And
    with unanimous consent I would also like to include the written
    statement of John Olsen for the record.
        [The prepared statement of Mr. Olsen appears on p. 108.]

                     U.S. Government Accountability Office
                       Report to Congressional Requesters
     ``CHEMICAL AND BIOLOGICAL DEFENSE: DoD and VA Need to Improve Efforts
    to Identify and Notify Individuals Potentially Exposed During Chemical
            and Biological Tests: Chemical and Biological Defense''
                           February 2008, GAO-08-366
                                 GAO Highlights
    Why GAO Did This Study
        Tens of thousands of military personnel and civilians were
    potentially exposed to chemical or biological substances through
    Department of Defense (DoD) tests since World War II. DoD conducted
    some of these tests as part of its Project 112 test program, while
    others were conducted as separate efforts. GAO was asked to (1) assess
    DoD's efforts to identify individuals who were potentially exposed
    during Project 112 tests, (2) evaluate DoD's current effort to identify
    individuals who were potentially exposed during tests conducted outside
    of Project 112, and (3) determine the extent to which DoD and the
    Department of Veterans Affairs (VA) have taken action to notify
    individuals who might have been exposed during chemical and biological
    tests. GAO analyzed documents and interviewed officials from DoD, VA,
    the Department of Labor, and a veterans service organization.
    What GAO Found
        Since 2003, DoD has stopped actively searching for individuals who
    were potentially exposed to chemical or biological substances during
    Project 112 tests, but did not provide a sound and documented basis for
    that decision. In 2003, DoD reported it had identified 5,842
    servicemembers and estimated 350 civilians as having been potentially
    exposed during Project 112, and indicated that DoD would cease actively
    searching for additional individuals. However, in 2004, GAO reported
    that DoD did not exhaust all possible sources of information and
    recommended that DoD determine the feasibility of identifying
    additional individuals. In response to GAO's recommendation, DoD
    determined continuing an active search for individuals had reached the
    point of diminishing returns, and reaffirmed its decision to cease
    active searches. This decision was not supported by an objective
    analysis of the potential costs and benefits of continuing the effort,
    nor could DoD provide any documented criteria from which it made its
    determination. Since June 2003, however, non-DoD sources--including the
    Institute of Medicine--have identified approximately 600 additional
    names of individuals who were potentially exposed during Project 112.
    Until DoD provides a more objective analysis of the costs and benefits
    of actively searching for Project 112 participants, DoD's efforts may
    continue to be questioned.
        DoD has taken action to identify individuals who were potentially
    exposed during tests outside of Project 112, but GAO identified four
    shortcomings in DoD's current effort. First, DoD's effort lacks clear
    and consistent objectives, scope of work, and information needs that
    would set the parameters for its effort. Second, DoD has not provided
    adequate oversight to guide this effort. Third, DoD has not fully
    leveraged information obtained from previous research efforts that
    identified exposed individuals. Fourth, DoD's effort lacks transparency
    since it has not kept Congress and veterans service organizations fully
    informed of the progress and results of its effort. Until DoD addresses
    these limitations, Congress, veterans, and the American public cannot
    be assured that DoD's current effort is reasonable and effective.
        DoD and VA have had limited success in notifying individuals
    potentially exposed during tests both within and outside Project 112.
    DoD has a process to share the names of identified servicemembers with
    VA; however, DoD has delayed regular updates to VA because of a number
    of factors, such as competing priorities. Furthermore, although VA has
    a process for notifying potentially exposed veterans, it was not using
    certain available resources to obtain contact information to notify
    veterans or to help determine whether they were deceased. Moreover, DoD
    had not taken any action to notify identified civilians, focusing
    instead on veterans since the primary impetus for the research has been
    requests from VA. DoD has refrained from taking action on notifying
    civilians in part because it lacks specific guidance that defines the
    requirements to notify civilians. Until these issues are addressed,
    some identified veterans and civilians will remain unaware of their
    potential exposure.
    What GAO Recommends
        GAO suggests that Congress direct DoD to develop guidance to notify
    potentially exposed civilians. GAO also recommends that DoD and VA take
    steps to improve their efforts to more effectively identify and notify
    individuals. DoD and VA generally agreed with most of the
    recommendations. However, DoD did not agree with the recommendation to
    conduct a cost-benefit analysis regarding additional Project 112
    research. As a result, GAO suggests that Congress direct DoD to conduct
    such an analysis.
        To view the full product, including the scope and methodology,
    click on http://www.GAO-08-9366. For more information, contact Davi M.
    D'Agostino at (202) 512-5431 or dagostinod@gao.gov.

                  Prepared Statement of Hon. Zachary T. Space,
              a Representative in Congress from the State of Ohio

        Thank you, Chairman Hall, Ranking Member Lamborn, and Members of
    the Subcommittee, for providing me with the opportunity to speak in
    favor of H.R. 5709, the ``Veterans Disability Fairness Act.''
        At the end of last year, the Oversight and Investigations
    Subcommittee held a hearing on an Institute for Defense Analyses report
    regarding the average disability payments received by veterans in each
    state.
        The hearing revealed that the VA's current data is lacking, and
    that ``regional cultures'' may be partly to blame for similarly
    disabled veterans receiving different ratings and thus, different
    disability payments. I introduced legislation specifically geared to
    correct these discrepancies.
        The Veterans Disability Fairness Act:

          Requires the VA to collect and monitor regional data on
    disability ratings.
          Requires the VA Secretary to conduct reviews and audits
    of the rating system.
          Requires the VA to submit a report yearly to Congress to
    track the progress of the program; and
          Requires VA raters to take ownership of their ratings by
    assigning identification codes to all adjudications. The performance of
    specific raters will then be evaluated periodically for consistency and
    accuracy.

        The current shortchanging in ratings is not reflective of our
    heroes' service, and there is no reason that a veteran from one state
    should receive less than veterans in other states. This legislation is
    an important step in addressing these issues and in providing needed
    oversight.
        Additionally, H.R. 5709 supplements this Subcommittee's work on
    Chairman Hall's H.R. 5892, the Veterans Disability Benefits Claims
    Modernization Act. Section 106 of that bill calls for an annual
    assessment of the quality assurance program that examines data from
    regional offices, the accuracy of evaluated claims, and creates
    automated, categorizable data to better identify trends. My bill will
    require accountability by enabling the specific identification of
    potentially problematic claims raters who may knowingly manipulate
    claims. Alternatively, my legislation will protect those who are doing
    their jobs with integrity.
        This bill is incredibly important to the veterans of Ohio; our
    state was ranked dead last in average disability payments, and I cannot
    stand for this. According to the IDA report, the national average
    disability payment is $8,890, and Ohio's average is $7,556. I believe
    we must act to restore parity to the disability payment system to
    ensure each veteran receives the full benefit he or she was promised.
    Senator Brown--a Member of the Senate Veterans' Affairs Committee--
    agrees and has introduced an identical companion version of my bill to
    the Senate.
        Thank you again for your consideration of H.R. 5709. I am grateful
    for the opportunity to present this important piece of legislation to
    you.

                                     ______

            Veterans Disability Disparity State by State Rankings \1\
    ------------------------------------------------------------------------

    ------------------------------------------------------------------------

    1. New Mexico----------------------------------------------------12,395-
    ------------------------------------------------------------------------
    2. Maine                                                         11,734
    ------------------------------------------------------------------------
    3. Oklahoma                                                      11,643
    ------------------------------------------------------------------------
    4. Arkansas                                                      11,412
    ------------------------------------------------------------------------
    5. West Virginia                                                 11,348
    ------------------------------------------------------------------------
    6. Nebraska                                                      10,719
    ------------------------------------------------------------------------
    7. Oregon                                                        10,677
    ------------------------------------------------------------------------
    8. Louisiana                                                      9,815
    ------------------------------------------------------------------------
    9. Vermont                                                        9,682
    ------------------------------------------------------------------------
    10. Kentucky                                                      9,673
    ------------------------------------------------------------------------
    11. North Carolina                                                9,549
    ------------------------------------------------------------------------
    12. Arizona                                                       9,502
    ------------------------------------------------------------------------
    13. Texas                                                         9,484
    ------------------------------------------------------------------------
    14. Montana                                                       9,460
    ------------------------------------------------------------------------
    15. Mississippi                                                   9,424
    ------------------------------------------------------------------------
    16. Rhode Island                                                  9,337
    ------------------------------------------------------------------------
    17. Washington                                                    9,156
    ------------------------------------------------------------------------
    18. South Dakota                                                  9,125
    ------------------------------------------------------------------------
    19. South Carolina                                                9,116
    ------------------------------------------------------------------------
    20. Tennessee                                                     9,111
    ------------------------------------------------------------------------
    21. Idaho                                                         9,063
    ------------------------------------------------------------------------
    22. Hawaii                                                        9,047
    ------------------------------------------------------------------------
    23. Wisconsin                                                     8,844
    ------------------------------------------------------------------------
    24. California                                                    8,755
    ------------------------------------------------------------------------
    25. Alabama                                                       8,752
    ------------------------------------------------------------------------
    26. Missouri                                                      8,721
    ------------------------------------------------------------------------
    27. Minnesota                                                     8,709
    ------------------------------------------------------------------------
    28. Florida                                                       8,617
    ------------------------------------------------------------------------
    29. Nevada                                                        8,606
    ------------------------------------------------------------------------
    30. Colorado                                                      8,476
    ------------------------------------------------------------------------
    31. Utah                                                          8,396
    ------------------------------------------------------------------------
    32. Wyoming                                                       8,360
    ------------------------------------------------------------------------
    33. Iowa                                                          8,348
    ------------------------------------------------------------------------
    34. Massachusetts                                                 8,348
    ------------------------------------------------------------------------
    35. New Hampshire                                                 8,317
    ------------------------------------------------------------------------
    36. Alaska                                                        8,300
    ------------------------------------------------------------------------
    37. New York                                                      8,278
    ------------------------------------------------------------------------
    38. Pennsylvania                                                  8,270
    ------------------------------------------------------------------------
    39. North Dakota                                                  8,237
    ------------------------------------------------------------------------
    40. Georgia                                                       8,163
    ------------------------------------------------------------------------
    41. Kansas                                                        8,052
    ------------------------------------------------------------------------
    42. New Jersey                                                    8,032
    ------------------------------------------------------------------------
    43. Michigan                                                      7,999
    ------------------------------------------------------------------------
    44. Illinois                                                      7,816
    ------------------------------------------------------------------------
    45. Connecticut                                                   7,737
    ------------------------------------------------------------------------
    46. Virginia                                                      7,706
    ------------------------------------------------------------------------
    47. Delaware                                                      7,679
    ------------------------------------------------------------------------
    48. Maryland                                                      7,654
    ------------------------------------------------------------------------
    49. Indiana                                                       7,573
    ------------------------------------------------------------------------
    50. Ohio                                                          7,556
    ------------------------------------------------------------------------
    Overall Average                                                   8,890
    ------------------------------------------------------------------------
    \1\ Institute for Defense Analyses Analysis of Differences in Disability
      Compensation in the Department of Veterans Affairs Vol. 1: Final
      Report pg. C-15 (December 2006).

                                     ______

                                          Congress of the United States
                                          U.S. House of Representatives
                                                        Washington, DC.
                                                          July 20, 2007
    President George W. Bush
    1600 Pennsylvania Ave., NW
    Washington, D.C. 20502

    Dear Mr. President,

        In visits to Veterans County Service Offices around my district, my
    staff hears time and again that veterans in Ohio are concerned about
    inconsistencies in the processing of seemingly similar disability
    claims. This week, the Associated Press published a story outlining the
    findings of the Institute for Defense Analyses' VA-commissioned study
    on veterans' annual disability pay from state to state. I am incredibly
    concerned about the report's assertion that Ohio ranks dead last.
        According to the report, approximately one-third of disparities may
    stem from correctible factors, such as inconsistent training standards
    for claims evaluators and simply placing too much power in the
    subjective decisions of evaluators. While demographic factors also play
    a role in overall ratings, I believe the human component can be
    improved upon.
        Your administration has a responsibility to ensure that the
    processes the VA utilizes are of the highest industry standard, and
    that those charged with overseeing those processes are doing so. In
    fact, during Secretary Nicholson's 2005 confirmation hearings, he
    pledged to look into the existing discrepancies. This week, as you
    know, he submitted his resignation without having sufficiently acted to
    standardize disability pay across state lines.
        That's why I am writing to demand that the next Secretary of the
    Department of Veterans Affairs make this the highest priority. The new
    Secretary must ensure that veterans in Ohio and others are not being
    treated unjustly and unfairly relative to the rest of the country.
        Mr. President, we absolutely owe it to the veterans of Ohio to get
    the bottom of why they are being shortchanged. I would appreciate
    knowing your response to this matter.

                Sincerely,

                                                             Zack Space
                                                     Member of Congress

                  Prepared Statement of Hon. Gus M. Bilirakis,
             a Representative in Congress from the State of Florida

        I would like to start by thanking Chairman Hall and Ranking Member
    Lamborn for including my legislation, H.R. 1197, on today's hearing
    agenda. The Prisoners of War Benefits Act is a bill that my father,
    former Representative Mike Bilirakis, first introduced several
    congresses ago. He was able to make some progress on the legislation
    before he retired in 2006, and I am pleased to be continuing his
    efforts on this important issue in the 110th Congress.
        The Prisoners of War Benefits Act is intended to improve the
    benefits currently available to former POWs. In 1981, Congress
    established several service-connected presumptions for certain medical
    conditions that affect former prisoners of war. However because a very
    high level of research certainty (95 percent) was required before
    establishing presumptive status, many other medical problems common in
    POWs have been excluded.
        My legislation establishes service-connected presumptions for two
    additional medical conditions: Type II diabetes and osteoporosis. My
    staff has worked with the American Ex-Prisoners-of-War to identify
    these conditions as having strong evidence of a relationship between
    the POW experience and the onset of the disease.
        Congress has passed legislation giving the Department of Veterans
    Affairs (VA) specific standards for determining whether the addition of
    new presumptive diseases for Vietnam and Gulf War veterans is
    warranted. These standards require a positive association for the
    adoption of a presumptive condition. However, Congress has not
    established a process for VA to add to the list of former POW
    presumptive diseases established in 1981. In 2001, the VA Advisory
    Committee on Former Prisoners of War recommended that the burden for
    establishing POW presumptions be adjusted to match the standards used
    for other beneficiary groups. Therefore, H.R. 1197 includes a provision
    to establish a process by which the VA could determine future
    presumptive conditions for former POWs when there is a positive
    association between the experience of being a prisoner of war and the
    occurrence of a disease or condition. Under my legislation, the VA
    Secretary would have to review the recommendations of the Advisory
    Committee on Former Prisoners of War and all other sound medical and
    scientific information and analyses available when making these
    determinations.
        Under current law, to be eligible for disability compensation for
    certain conditions presumed to be service-connected for former POWs, a
    veteran must have been held in captivity for 30 or more days.
        At the time when some of the original POW presumptions were
    enacted, short-term prisoners of war were unusual. Prisoners of war
    from more recent conflicts have been confined for shorter periods of
    time. H.R. 1197 would remove the 30-day minimum requirement, making all
    former POWs eligible regardless of how long they were held captive.
    This provision is based on the recommendations of the VA's Advisory
    Committee on Former Prisoners of War, which concluded in 2001 that this
    30-day requirement should be repealed.
        The 108th Congress did enact a partial repeal of the 30-day minimum
    requirement as part of the Veterans Benefits Act of 2003 (Public Law
    108-183). Specifically, this law eliminated the requirement that a POW
    be held for 30 days or more to qualify for presumptions of service-
    connection for certain disabilities. Although I am pleased that
    Congress took this initial step, I believe that more can be done in
    this regard and urge my colleagues to support H.R. 1197 for this
    reason.
        Before I close, I would like to mention how pleased I am that we
    have also included H.R. 5454 on today's agenda. H.R. 5454, which I have
    cosponsored, would establish a presumption of service-connection for
    ALS. I have heard from some of my constituents whose loved ones suffer
    from this devastating disease. They firmly believe there is a link
    between their loved ones military service and their developing ALS.
        In closing Mr. Chairman, I want to thank you once again for
    including my bill in today's hearing. I hope that you and our other
    colleagues on the Subcommittee will support H.R. 1197 and H.R. 5454. I
    look forward to hearing the testimony from today's witnesses.

                      Prepared Statement of Hon. David Wu,
             a Representative in Congress from the State of Oregon

        Chairman Hall, Ranking Member Lamborn, distinguished Members of the
    Subcommittee:
        Thank you for the opportunity to testify today on behalf of H.R.
    3008, the Rural Veterans Services Outreach and Training Act.
        A few years ago, I was made aware of a problem that directly
    affects millions of individuals who have defended our country. Due to
    budget cuts in many areas--including my home state of Oregon--county
    veterans service officers are not being funded at adequate levels.
        County veterans service officers provide veterans with advice and
    casework service about their VA benefits. There is a singular need for
    these services in our rural communities. There are approximately 3
    million veterans living in rural areas in the United States. A 2004
    report published in the American Journal of Public Health indicates
    that veterans in rural areas are in poorer health than their urban and
    suburban counterparts. Without access to casework services, these
    veterans go without all the benefits they need, deserve, and have
    earned.
        Some may argue that veterans in rural areas can simply drive to the
    nearest VA Regional Office. But for many veterans and their caregivers,
    this is impractical. According to the National Rural Health
    Association, the average distance a rural veteran must travel to get
    care is 63 miles. For someone who has endured the trauma of a
    battlefield injury and begun the long, arduous process of
    rehabilitation, this is often, simply, too much to ask.
        Without access to a county veterans service officer, veterans must
    rely solely on customer service representatives over the telephone or
    Internet in order to access their VA services. But anyone who has ever
    encountered an automated phone system knows how frustrating and
    discouraging this can be. Veterans who have suffered physical,
    emotional, or psychological injuries should not be forced to navigate
    the VA bureaucracy alone because they do not live near a VA Regional
    Office.
        Our veterans deserve better, have earned better, and will get
    better under this bill. County veterans service officers provide rural
    communities with more than just their expertise. I believe our veterans
    are served best by their fellow community members. Community members
    understand a veteran's needs as they relate to his or her community,
    job, and family. Armed with this information, county veterans service
    officers can best advocate for the veterans they serve.
        With this in mind, I introduced the Rural Veterans Services
    Outreach and Training Act, which seeks to improve outreach and
    assistance to veterans and their families residing in rural areas.
        This bill establishes a competitive grant program at the Department
    of Veterans Affairs to help eligible states hire and train county
    veterans service officers for their rural communities.
        The Rural Veterans Outreach and Training Act targets grant money to
    the communities that need it most. This legislation requires that
    grants will be used only to supplement non-Federal funding sources, not
    supplant them.
        We have an obligation to ensure that veterans--wherever they
    reside--have access to the services they have earned and deserve. Our
    men and women in uniform give so much in service to our country, and I
    believe we should act accordingly to ensure they have access to local
    assistance to find the help they need.
        Again, I appreciate the Subcommittee's consideration of the Rural
    Veterans Services Outreach and Training Act. On behalf of a grateful
    nation and veterans everywhere, I look forward to working with you on
    this important legislation.

                  Prepared Statement of Hon. Thomas H. Allen,
              a Representative in Congress from the State of Maine

        Thank you, Mr. Chairman, for convening this hearing on very
    important veterans' disability assistance bills, including my proposal,
    H.R. 5448, the ``Full Faith in Veterans Act of 2008.'' I am extremely
    grateful for this opportunity to testify before the Subcommittee about
    the need for my legislation, which I introduced in February of this
    year.
        The enormous stress of combat has long been recognized as the
    source of long-term, disabling psychological and emotional illness for
    many soldiers, sailors, marines and airmen. What we now know as post
    traumatic stress disorder, or PTSD, is not a new phenomenon. The wars
    in Iraq and Afghanistan, however, have been particularly stressful,
    given the unpredictability of ambushes and IED attacks, not knowing who
    is friend or foe, and repeated tours of duty. In addition, military and
    medical personnel more readily recognize the symptoms of this disorder.
    So it is not surprising that so many of our brave men and women return
    from Iraq and Afghanistan suffering from incapacitating fears,
    flashbacks, nightmares and other problems associated with their
    experiences. The Department of Veterans Affairs (VA) has diagnosed PTSD
    in about 67,000 Iraq and Afghanistan veterans. Because many veterans do
    not seek care for these problems, the true number is undoubtedly much
    higher.
        PTSD has affected those who have served in our Armed Forces since
    the days it was known as ``shell shock.'' Thousands of veterans from
    previous conflicts continue to struggle with the long-term effects of
    their service. Others have had their symptoms reemerge as a result of
    the extensive news coverage of the events of September 11, 2001, and
    the ongoing wars in Iraq and Afghanistan.
        The goal of the Full Faith in Veterans Act is to improve diagnosis,
    compensation, and treatment for veterans with PTSD.
        The primary component of the legislation seeks to ensure that every
    veteran whose PTSD resulted from their service receives treatment and,
    if appropriate, disability compensation.
        Veterans for Common Sense reviewed VA documents to determine the
    number of Iraq and Afghanistan veterans diagnosed with PTSD--about
    67,000. The organization also found the VA concluded that only about
    half of these veterans have a service-connected disability. This raises
    the question of the status for the other 30,000 or so veterans. Some
    veterans may not know they can file a claim or may still have a claim
    pending. But as I have learned from veterans in my district, proving
    that PTSD is service-connected can be very difficult, particularly for
    veterans of older conflicts. And denial of service-connection leaves
    these veterans without access to VA health benefits or disability
    compensation.
        I crafted my bill after listening to Maine veterans victimized by
    the current system. In many cases, the law appears to be stacked
    against them. Instead of the support and quality healthcare they were
    promised, the disabling trauma they suffered during military service
    has been met with skepticism and red tape. I would like to share the
    story of one of my constituents that brings these shameful
    circumstances to life.
        Terry Belanger is an Army veteran from Biddeford, Maine. He served
    in Vietnam from 1969-1970. Terry's principal duty was to serve as a
    light vehicle driver; his responsibilities included delivering and
    distributing ammunition to troops surrounding Chu Lai Air Base.
        Terry's time in Vietnam was harrowing. His vehicle came under enemy
    fire, he reports, ``practically every night.'' Close friends were
    killed in combat; another died in a stabbing over a game of cards; he
    witnessed the torture of Viet Cong officers, and saw the body of the
    driver of the truck ahead of his fly through a canvas top after the
    vehicle struck a mine; he slept in the mud and saw body bags being
    loaded on to U.S. planes. His captain was killed.
        On one mission, a young Vietnamese girl suddenly appeared in front
    of his truck and his vehicle ran over the little girl, probably killing
    her. Because his convoy was under fire, he could not stop. Terry's
    nightmares about this incident were rekindled a few years ago after he
    nearly struck another child who darted in front of his car.
        When he returned from Vietnam, Terry showed evidence of what
    several healthcare professionals have diagnosed as severe PTSD
    resulting from his service in Vietnam. It took him 6 months to want to
    hold his newborn daughter, but he didn't know why. In 1989, Terry filed
    a claim with the VA for service-connected PTSD. The claim was denied
    due to ``lack of credible information of supporting stressors.'' Terry
    would spend nearly two decades fighting his own government, a
    government he had fought to defend. Time and again, the VA denied
    service-connection due to lack of evidence that his condition was
    linked to his military service. All the while, Terry and his family
    suffered, for his government would neither pay for his medical care for
    PTSD, nor provide him with disability benefits.
        For 19 years, Terry tried to get the Army to search for documents
    that would prove that these traumatic events had occurred. In January
    1993, the National Personnel Records Center told Terry that the records
    he requested ``would rarely show specific details about a unit's
    activities and movements and that it was unable to perform the
    extensive research requested due to staffing and budget limitations.''
    Finally, in 2005, the National Archives and Records Administration
    found over 4,500 pages that verified that Terry's unit was in combat
    for months, just as he had claimed. This was sufficient to establish
    service-connection. But because of an enormous backlog of veterans'
    claims, Terry had to wait another 3 years before the VA would grant his
    claim.
        Last month, he finally received the VA's decision that it would
    grant his claim. Terry says that it took him 3 days to stop being
    angry, and he'll never understand why it took them so long to validate
    his claim.
        It took that long because the law is unfair. The veteran, not the
    agency that possesses the records, has the burden of producing
    documents that prove the trauma occurred. How was Terry Belanger, a
    disabled veteran in Biddeford, Maine, supposed to find the records that
    the government said it didn't have the time or money to look for? His
    doctors confirmed he had PTSD. His nightmares and flashbacks referred
    to his time in Vietnam. The Army trusted him when he served his
    country. Why should we distrust him now, in his time of need?
        Indeed, what is remarkable about Terry's case is that the records
    were ever uncovered. It happened only because Terry was so persistent
    and would not let his family down. He kept filing and appealing until
    finally, after 16 years, someone in the National Archives found
    thousands of pages that they had missed before.
        Terry's story is similar to many I have heard from veterans in
    Maine and, I would wager, is much like the experience veterans in each
    of your districts have had. In many cases, no records are kept of
    traumatic experiences in a combat theatre. As Terry had been told
    earlier, military records ``would rarely show specific details about a
    unit's activities and movements.'' In the case of Terry Belanger, the
    records were there amid millions of others. Either way, bureaucratic
    mismanagement or red tape is no excuse to deny veterans the healthcare
    and compensation they have earned.
        When no records can be found to substantiate the claim, a veteran
    can also submit two ``buddy statements'' as evidence that their claimed
    stressor actually occurred. Again, the burden of proof is placed on the
    veteran to find fellow servicemembers who may remember and can
    corroborate the veteran's story. This is not an easy task, particularly
    when seeking individuals that the veteran may not have seen or spoken
    to for decades. One can turn to the back of many veterans' magazines
    and see ads submitted by veterans looking for others who can verify
    their claims, like these (all from the April 2008 issue of VFW
    magazine):

            ``173rd [Airborne] Support [Battalion], An Khe, Vietnam, 1968-
            69--Seeking anyone who attend [sic] [Airborne] Jungle School
            when one of the instructors was accidentally shot by one of the
            other instructors next to me; anyone there when the school and
            mess hall were shelled and three people were killed; cooks and
            supply people; Sergeant Provost and Jimmy Gibson; anyone who
            was there when the mess hall caught on fire and we put it out;
            anyone who witnessed an accidental shooting on April 9, 1968,
            in the bunkhouse. Need substantiation for PTSD claim.--William
            E. Young, Jr.''

            ``222nd Personnel Services [Company], Vietnam, early 1971--
            Seeking anyone in a convoy traveling between Vaung Tan and Long
            Binh and saw Huey shot down. Need substantiation for PTSD
            claim.--John Westbrook''

            ``4th [Infantry Division Artillery] Base Camp, Pleiku, Vietnam,
            Sept. 1969-Nov. 1970--Seeking anyone attached to camp. Need
            substantiation for PTSD claim.--Roger Carroll''

        Veterans should not have to take out classified ads in order to
    have their valid claims for PTSD approved by the VA.
        Under my common sense bill, if a veteran is diagnosed by a
    certified medical health professional as suffering from PTSD related to
    the veteran's military service, the VA must accept this finding as
    sufficient proof of service-connection. As with other disability
    claims, the VA must resolve every reasonable doubt in favor of the
    veteran. However, the VA can rebut this finding of service-connection
    by clear and convincing evidence to the contrary. Thus, if contrary
    evidence exists, and the VA produces it, the claim will not be allowed.
        Under my bill, veterans like Terry Belanger would not have to wait
    two decades for the VA to find the relevant records. The law would also
    help the many veterans whose traumatic experience in the service never
    made it into official records. The new standards in my bill would apply
    to all veterans diagnosed with PTSD, not just those from the wars in
    Iraq and Afghanistan. It would also acknowledge the inherent dangers of
    military service and be applicable to all those who served our Nation
    in uniform, not just those who faced combat. It also accommodates cases
    of PTSD related to military sexual trauma that may not have happened in
    a combat zone.
        In addition to establishing a fair system for establishing service-
    connection for PTSD, the bill would also ensure that the VA does a
    better job at diagnosing and treating this debilitating disorder.
        The bill requires that VA employees who are responsible for rating
    disability compensation claims involving PTSD successfully complete a
    certification program that incorporates best practices issued by the
    VA's National Center on PTSD.
        It directs the VA to audit the examinations that VA mental health
    professionals conduct for veterans who submit claims for PTSD
    disability compensation. This will help ensure these employees take
    enough time to diagnose and accurately rate the severity of the
    disorder.
        H.R. 5448 requires that the documents mental health professionals
    and raters consider when evaluating or rating PTSD must include the
    veteran's records from VA Vet Centers, as well as written opinions of
    any medical professional providing mental healthcare.
        The bill also directs the VA to update the schedule for rating
    disabilities, beginning with PTSD, traumatic brain injury, and other
    disabling mental health conditions.
        Finally, my measure requires the VA to implement an approach for
    providing treatment for veterans with PTSD that combines treatment,
    compensation, and vocational assessment.
        This bill has received support from a broad array of veterans
    groups, including Swords to Plowshares, Veterans for Common Sense, the
    Maine Veterans Coordinating Committee and Maine's Bureau of Veterans
    Services, along with the Maine departments of the American Legion,
    AMVETS, the Disabled American Veterans, and the Veterans of Foreign
    Wars.
        For too long, America has neglected our responsibilities to the men
    and women who carry the emotional scars military service sometimes
    brings. They battled for us; now we must help them battle their demons,
    by treating them fairly and respectfully. Terry Belanger's wife wrote,
    ``This wonderful man--left part of his soul in Vietnam.'' I hope and
    pray that with care and support, Terry and other veterans suffering
    from PTSD will be restored to full and productive lives. The Full Faith
    in Veterans Act can help achieve this.

                                     ______

                                                   Swords to Plowshares
                                                     San Francisco, CA.
                                                          March 4, 2008
    Hon. Thomas H. Allen
    United States House of Representatives
    1127 Longworth House Office Building
    Washington, DC 20515-1901

    Dear Representative Allen,

        I write on behalf of Swords to Plowshares to thank you for
    introducing the Full Faith in Veterans Act (H.R. 5448). Swords to
    Plowshares is a non-profit Veterans Service Organization founded by
    Vietnam Veterans in 1974 and dedicated to providing services and
    support to veterans of all eras. Our legal staff have assisted
    countless veterans through the complex Veterans Benefits Administration
    (VB A) claims process to secure compensation for Post Traumatic Stress
    Disorder (PTSD) incurred during service to our country.
        H.R. 5448 addresses serious flaws in the adjudication of PTSD
    claims. Under current law, veterans must have both a PTSD diagnosis and
    military documentation of the traumatic stressor which caused their
    PTSD, or two ``buddy statements'' describing the event. This process of
    identifying two ``buddies'' and eliciting their description of painful
    events causes undue trauma to all the veterans involved, and is
    triggered by a failure in military documentation for which the veteran
    has no control. The proposal to accept a diagnosis of PTSD by a mental
    healthcare professional that establishes a logical relationship between
    exposure to military stressors and current PTSD is a vast improvement
    over the current process.
        We also applaud the effort to establish standards in PTSD case
    review through: the requirement that VBA PTSD Ratings Analysts complete
    a certification program incorporating best practices issued by the VA's
    National Center on PTSD; the requirement that VA audit their mental
    health examinations to ensure that sufficient time is taken to
    accurately diagnose and rate the severity of PTSD; and, the requirement
    that the Ratings Analysts consider Vet Center records and written
    opinions of other treating medical professionals in assessing PTSD
    claims.
        Thank you on behalf of Swords to Plowshares for your leadership in
    veterans' issues and we look forward to working with you and your staff
    to support the Full Faith in Veterans Act.

                Sincerely,
                                                        Michael Blecker
                                                     Executive Director

                                     ______

                                              Veterans for Common Sense
                                                        Washington, DC.
                                                          June 10, 2008
    The Honorable Thomas Allen
    Member of Congress
    U.S. House of Representatives
    1127 Longworth House Office Building
    Washington, DC 20515

    Dear Representative Allen:

        Veterans for Common Sense (VCS) strongly supports your new bill,
    ``The Full Faith in Veterans Act,'' H.R. 5448. VCS asks Chairman John
    Hall and the House Veterans' Affairs Committee's Subcommittee on
    Disability Assistance and Memorial Affairs to favorably report the bill
    at their hearing on June 12, 2008. Our VCS goal is simple: We want VA
    to quickly and accurately process post traumatic stress disorder claims
    so our veterans are not forced to wait months or years for disability
    benefits. We thank you for your leadership on this important issue.
        The Department of Veterans Affairs' (VA) disability claims process
    for Iraq and Afghanistan War veterans remains broken--as shown by the
    fact that VA takes, on average, more than 6 months to process an
    initial claim, and VA takes nearly four more years to process a
    disability claim appeal. Among the most difficult claims to process are
    PTSD claims. VCS supports a presumption of a PTSD stressor based on
    deployment to a war zone.
        VCS remains alarmed that VA denies more than half of the PTSD
    disability benefits filed by Iraq and Afghanistan war veterans. The
    latest publicly available information shows that only 37,000 Iraq and
    Afghanistan war veterans' VA disability claims for PTSD were approved
    among the 75,000 veterans diagnosed at VA hospitals with PTSD. While
    some cases may be pending or on appeal, VA's rejection rate is
    suspiciously high, and the enormous disparity warrants a prompt
    Congressional oversight investigation above and beyond enacting H.R.
    5448.
        Your bill, H.R. 5448, requires VA reports on PTSD. VCS urges
    Congress to pass H.R. 1354, ``The Lane Evans Veterans Health and
    Benefits Improvement Act,'' a bill that requires VA to collect data and
    prepare reports about the human and financial costs of the Iraq and
    Afghanistan wars. VCS believes Congress should also ask VA how many
    non-Iraq and Afghanistan war veterans are diagnosed with PTSD by VA,
    and how many of those have approved PTSD claims. This information
    should shed more light on the issue of how VA handles PTSD healthcare
    and for claims for all our Nation's veterans.

                Sincerely,
                                                          Paul Sullivan
                                                     Executive Director

                                     ______

           ``Vietnam Veterans Seek Proof Of Stress-Inducing Events''
                              The Hartford Courant
                    By Ann Marie Somma, Courant Staff Writer
                                  May 25, 2008
        A Vietnam veteran from South Carolina is searching for three scuba
    divers who helped him fish dead bodies out of Cam Rahn Bay in Vietnam
    in 1967.
        An air rescue medic now living in Maine is desperately seeking
    anyone who remembers him killing 18 North Vietnamese during the Tet
    Offensive between January and March 1968.
        A Brookfield vet is hoping to find someone else who saw the
    explosion of a F-100 fighter bomber aircraft at the Bien Hoa air base
    in Vietnam in 1966.
        Every month, the Vietnam Veterans of America's magazine website is
    clogged with personal ads posted by vets around the country diagnosed
    with post traumatic stress disorder. They may have survived harrowing
    experiences in Vietnam, but the U.S. Department of Veterans Affairs
    won't approve their claims for disability unless they can document the
    exact traumatic episode that triggered the disorder.
        Because the service records of so many Vietnam veterans are
    incomplete and inaccurate, often their only hope is to find a fellow
    soldier who will write to the VA confirming the traumatic event, known
    as an in-service stressor.
        The letters are known, affectionately, as buddy letters.
        Robert Chechoski, a Vietnam veteran in Bridgeport who volunteers
    his time to help other vets file PTSD disability claims, said the need
    to produce buddy letters and to prove their trauma is hurtful for those
    who still remember their bitter homecoming.
        ``They hid for 30 years. They tried to put Vietnam out of their
    mind. A lot worked the midnight shift, because they can't deal with
    people, a lot drank to forget,'' Chechoski said. ``Then something
    awakens in their head, they go get counseling and help and a lot get
    denied by the VA.''
    Burning Embers
        The veterans seeking buddy letters served in every branch of the
    military. They saw soldiers die. Their lives were threatened in
    ambushes, rocket attacks and shelling in villages and the jungle.
        But their military records typically don't include an account of
    the single traumatic event they witnessed. Their DD214s, the military
    service records issued by the Department of Defense, are incomplete and
    inaccurate. Some troops left Vietnam with no records at all. Those who
    served in top secret government missions were, in essence, never there.
        Veterans advocates say the VA's arcane standard of requiring
    evidence of an in-service stressor has denied thousands of veterans
    disability pay and continues at a time when the number of Vietnam-era
    veterans being treated for PTSD in the VA system is increasing.
        A 2007 study by Robert Rosenheck and Alan Fontana, two Yale
    University researchers, found that the number of those vets being
    treated for PTSD increased from 91,043 in 1997 to 189,309 in 2005. Some
    experts believe the war in Iraq is triggering Vietnam memories, causing
    the spike in numbers.
        Before the government officially recognized PTSD in 1980, thousands
    of Vietnam veterans became homeless, turned to drugs and alcohol or
    died. The VA now considers PTSD a disability and uses a rating system,
    from 10 to 100 percent, to determine how the illness has affected a
    veteran's quality of life, relationships and ability to earn a living.
    Compensation ranges from a few hundred dollars to $2,500 a month.
        Chechoski, who served three tours in Vietnam and was diagnosed with
    PTSD in 1996, offered an explanation of the delayed effects of the
    disorder.
        ``Picture a Weber grill. You set a bag of charcoal on fire, then
    you douse it with a 10-gallon bucket of water. You think you got that
    fire out, but there is one ember that is still alive and it will ignite
    sooner or later,'' Chechoski said.
        Armand Flynn's ember ignited on Sept. 11, 2001, after smoldering
    for more than 30 years.
        The Brookfield veteran dealt with Vietnam by living a simple life.
    He graduated from college, married and raised three children with a
    career administering compensation benefits for major corporations. But
    he drank too much. The liquor quelled his panic attacks and insomnia.
        On Sept. 11, when the hijacked planes hit the World Trade Center,
    Flynn flashed back to Vietnam on Oct. 6, 1966.
        Flynn says he was working the flight line attached to the U.S. Air
    Force 6234 Tactical Fighter Wing when a plane loaded with cannons and
    air-to-air missiles caught fire on the runway at the Bien Hoa air base.
        ``I saw that pilot go by me minutes earlier, then his plane blew up
    like an atom bomb. There was fire and noise, stuff cooking off the
    plane,'' said Flynn, 63.
        After the flashback he had a breakdown, and shortly after that he
    sought help at the VA in West Haven. A doctor there diagnosed him with
    PTSD and prescribed a cocktail of pharmaceuticals to ease his
    depression, panic attacks and insomnia.
        The explosion is recorded in the history of Flynn's Air Force unit.
    But VA personnel trained to search military archives can't find a
    record of his service in Vietnam.
        Flynn says he flew from California for duty in Vietnam in August
    1966 and remained there until October before moving to his permanent
    assignment in Korat, Thailand. The VA says his service records place
    him only in Thailand.
        Last year, seeking a buddy letter to prove he was at the air base,
    Flynn placed an announcement in the Vietnam Veterans of America
    magazine.
        Hurbert Bradshaw in California responded to Flynn's post. He says
    he served with Flynn in the 6234 Tactical Fighter Wing in Vietnam and
    wrote the VA that Flynn was in Vietnam with him.
        ``I met [Flynn] in Bien Hoa, that's why I wrote the letter,''
    Bradshaw said.
        The VA denied Flynn's claim, despite the letter. He is on his third
    appeal.
        ``This has been really painful. Every time I have to appeal, I have
    to reconstruct the stressors, all the things that I buried are coming
    back, the memories, the nightmares,'' Flynn said.
        He wonders how long he can battle the government, a quest, he said,
    that has strained his 37-year marriage. He no longer works and relies
    on VA health benefits. He attends a PTSD group therapy session at the
    VA every Thursday.
        ``Is there anything else I missed, anybody I need to contact? Maybe
    there is a second person? I don't know what to do,'' Flynn said.
    Fixing The Process
        Veterans groups have lobbied the VA to modernize the PTSD claims
    process, and there are efforts in Congress to eliminate the rule that
    requires proof of an in-service stressor. Now, unless a veteran
    received a Combat Infantryman Badge or Purple Heart, their stressor
    must be documented.
        U.S. Rep. Tom Allen, D-Maine, introduced legislation in Congress
    this year that would eliminate the need for veterans to prove a
    stressor to receive disability compensation for PTSD.
        ``What these guys experienced transcends military records,'' Allen
    said. ``We owe it to them. We shouldn't deny them benefits and
    treatments on a technicality.''
        Under Allen's Full Faith in Veterans Act of 2008, a diagnosis of
    PTSD by a mental healthcare professional who establishes a logical
    relationship between exposure to military stressors and current PTSD
    symptoms is enough to prove that the PTSD is service connected.
        At a press conference earlier this year, Allen told a group of
    veterans that his father was the inspiration behind the bill. His
    father volunteered for the Navy after Pearl Harbor, working control
    towers on air bases in the South Pacific. The towers were bombed
    nightly.
        But what affected Allen's father the most were the pilots who never
    returned from missions.
        ``My father never told me a lot about what happened to him during
    the war, but I know that when he came back he had what today would be
    diagnosed as PTSD,'' Allen said.
        Allen said the VA system needs to be overhauled to deal with the
    impending flood of PTSD claims from those serving in Iraq and
    Afghanistan. A recent study conducted by the RAND Corporation found
    that one in every five soldiers, or 300,000 troops of the estimated 1.7
    million who have been deployed to Iraq and Afghanistan, have depression
    and some sign of PTSD.
        ``There are no frontlines in Iraq, and we are going to have the
    lingering effects of PTSD for a long time,'' Allen said.
        Aaron Entrekin, a Vietnam veteran from Tennessee, said he drank
    himself through two wives and countless jobs before seeking help at the
    local VA hospital. Doctors there diagnosed him with PTSD in 2001, but
    he hasn't found anyone to confirm his stressor.
        Entrekin said he ran over a Vietnamese boy while driving a truck in
    a convoy heading south from Da Nang. He doesn't remember the exact
    year; 1970 or 1971, he guesses. But he'll never forget the boy's face.
        ``His dad was holding him in his arms. I see him every night in my
    dreams and when I close my eyes,'' Entrekin said. ``He was trying to
    cry, he was bleeding out of his mouth, nose and ears.''
        Entrekin wanted to take the boy to the hospital.
        His lieutenant ordered him to keep driving.
        The U.S. Army has no record of the accident. The VA has denied his
    claim three times.
        His announcement in the Vietnam veterans magazine in search of a
    buddy letter reads, ``They called me Slim or Hillbilly.'' Entrekin
    hopes the nicknames will jar the memory of someone who served with him
    in the U.S. Army's 25th Infantry Division 18th Engineer Brigade.
        ``If you ain't got a Purple Heart, they don't want to help you,''
    he said. ``There are a lot of bad things that happened to people in
    Vietnam who didn't get a Purple Heart.''

               Prepared Statement of Judith A. Salerno, M.D., MS,
       Executive Officer, Institute of Medicine of the National Academies

        Chairman Hall asked the Institute of Medicine (IOM) of the National
    Academies to provide testimony regarding several bills under
    consideration by the Subcommittee. In response, we have prepared this
    testimony on issues raised in these bills that are addressed by recent
    IOM reports.
        My name is Dr. Judith Salerno and I am the Executive Officer of the
    Institute of Medicine. I serve as IOM's chief operating officer and
    executive director of the Institute, and am responsible for managing
    IOM's research programs. My past work includes positions at the
    Department of Veterans Affairs (VA), where I directed the continuum of
    VA's Geriatrics and Extended Care programs across the country. I also
    previously served as Associate Chief of Staff at the VA Medical Center
    in Washington, D.C., where I coordinated clinical services for older
    veterans. I am honored to have had the opportunity to serve veterans
    for 9 years in these capacities.
        The reports I will be discussing today were written by committees
    of experts convened under the auspices of the Institute of Medicine.
    IOM was created in 1970 as a component of the National Academy of
    Sciences, which was chartered by Congress in 1863. The National
    Academies' role is to provide independent, non-partisan, evidence-based
    advice to the Government and the Nation. As an independent voice, we
    neither support nor oppose the legislation under discussion at today's
    hearing.
        I will address provisions in seven of the bills that touch on
    topics covered in IOM reports.
    H.R. 1197: Prisoner of War Benefits Act of 2007
        H.R. 1197 addresses issues related to the establishment of
    presumptions of service connection. The 2008 IOM report Improving the
    Presumptive Disability Decision-Making Process for Veterans describes
    the current process for making presumptive decisions for veterans who
    have health conditions arising during military service and proposes a
    scientific framework for making such decisions in the future. The
    report was requested by the Congressionally constituted Veterans'
    Disability Benefits Commission. Its findings and recommendations were
    previously delivered to the Subcommittee in testimony presented on
    February 26, 2008 by Jonathan M. Samet, MD, MS, and, in the interest of
    brevity, won't be repeated here. H.R. 3795, 5454, 5954, and 6032--which
    also deal with presumptions of service connection--are discussed below.
    H.R. 3795: You Were There, You Get Care Act of 2007
        H.R. 3795 would add a presumption of radiation exposure for the
    purpose of service connection for veterans of the 1991 Persian Gulf War
    and subsequent conflicts in that theatre. The bill also calls for an
    independent study to determine diseases that may result from exposure
    to depleted uranium.
        In 1998, VA asked the IOM to convene a committee and to evaluate
    the scientific literature regarding potential health effects from
    exposure to depleted uranium. The committee's report--Gulf War and
    Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and
    Vaccines--was released in 2000. It concluded that there was inadequate
    or insufficient evidence to determine whether an association exists
    between uranium exposure and 14 health outcomes--lymphatic cancer, bone
    cancer, nervous system disease, reproductive or developmental
    dysfunction, nonmalignant respiratory disease, gastrointestinal
    disease, immune-mediated disease, effects on hematologic measures,
    genotoxic effects, cardiovascular effects, hepatic disease, dermal
    effects, ocular effects, and musculoskeletal effects. The committee
    also concluded that there was limited or suggestive evidence of no
    association between uranium and clinically significant renal
    dysfunction and between uranium and lung cancer at cumulative internal
    doses lower than 200 mSv.
        IOM is preparing an update of this report, which will include
    reviews of new scientific literature available since publication of the
    2000 report. This update is expected to be released in the fall of
    2008. In addition, the IOM has been asked by the Department of Defense
    to determine if it is feasible to conduct an epidemiological study of
    veterans who were exposed to depleted uranium while on active duty. A
    report addressing this question will be released later this year.
    H.R. 5448: Full Faith in Veterans Act of 2008
        H.R. 5448 includes provisions that instruct the VA to update the
    rating criteria used to evaluate Post Traumatic Stress Disorder (PTSD)
    for compensation purposes and to create a training and certification
    program for the employees who perform the ratings.
        In June 2007, a committee convened by the IOM at the request of the
    VA completed a report entitled PTSD Compensation and Military Service.
    The committee's review identified several areas where changes in
    current practice might result in more consistent and accurate ratings
    for disability associated with PTSD. Such ratings are performed by VA
    raters using information gathered in a compensation and pension
    examination and criteria set forward in the Schedule for Rating
    Disabilities. Currently, the same set of criteria is used for rating
    all mental disorders. They emphasize symptoms from schizophrenia, mood,
    and anxiety disorders. The committee found that these criteria are at
    best a crude and overly general instrument for the assessment of PTSD
    disability. It recommended that new criteria be developed and applied
    that specifically address PTSD symptoms and that are firmly grounded in
    the standards set out in the Diagnostic and Statistical Manual of
    Mental Disorders used by mental health professionals.
        Determining ratings for mental disabilities in general and for PTSD
    specifically is more difficult than for many other disorders because of
    the inherently subjective nature of symptom reporting. In order to
    promote more accurate, consistent, and uniform PTSD disability ratings,
    the committee recommended that VA establish a certification program
    specifically for raters who deal with PTSD claims, with the training to
    support it, as well as periodic recertification. Rater certification
    should foster greater confidence in ratings decisions and in the
    decisionmaking process.
    H.R. 5454: To amend title 38, United States Code, to establish a
            presumption of service connection of amyotrophic lateral
            sclerosis for purposes of the laws administered by the
            Secretary of Veterans Affairs
        H.R. 5454 would establish a presumption of service connection for
    ALS. The available research on ALS in veterans was evaluated in an IOM
    study requested by the VA that resulted in the 2006 report Amyotrophic
    Lateral Sclerosis in Veterans: Review of the Scientific Literature.
    Only five studies on this topic were identified. The committee charged
    with performing the review found that there was limited or suggestive
    evidence of an association between military service and development of
    ALS. It recommended that additional studies on the relationship between
    military service and ALS be conducted and that, in addition, research
    was needed to explore what might be causing ALS among veterans: for
    example, involvement in traumatic events, intensive physical activity,
    or chemicals or other substances or activities that might be
    encountered during military service.
    H.R. 5709: Veterans Disability Fairness Act
        H.R. 5709 would require the Secretary of the Department of Veterans
    Affairs to perform annual reviews of the accuracy and consistency of
    decisions on disability compensation and take those results into
    account in reviewing the performance of Veterans Benefit Administration
    and Board of Veterans Appeals adjudicators. The June 2007 IOM report A
    21st Century System for Evaluating Veterans for Disability Benefits
    found that VA's quality assurance effort has improved the accuracy of
    disability benefit decisions from less than 60 percent in 2000 to 88
    percent in 2006, which is commendable but still leaves considerable
    room for improvement. This report was requested by the Veterans'
    Disability Benefits Commission.
        The 21st Century System report also found that VA's quality
    assurance system did not address consistency of decisions across VA's
    58 field offices. The report recommended ongoing or periodic
    evaluations of inter-rater reliability as well as the accuracy and
    validity of ratings across field offices and impairment categories
    (Recommendation 5-4). The report similarly recommended periodic
    assessment of the inter-rater reliability of the disability
    examinations performed by the Veterans Health Administration, which are
    a key input to the disability determination process (Recommendation 5-
    3). It should be noted, however, that the report stated that
    variability cannot be totally eliminated in evaluating most disabling
    conditions, because there will always be conditions with significant
    subjective elements such as mental disorders and back and joint pain.
    The report, therefore, emphasized using quality assurance results to
    improve the controllable elements of the decisions making system, for
    example, by revising guidelines, training, and/or rater qualifications
    and performance standards. It should also be noted that the main
    finding of the 21st Century System report was that the VA Schedule for
    Rating Disabilities is badly out of date for certain body systems such
    as musculoskeletal disorders, thereby hindering raters from providing
    accurate assessments of veterans' disabilities. The report recommended
    that VA immediately update the Rating Schedule using current medical
    knowledge, which should itself improve the accuracy and consistency of
    rating decisions.
    H.R. 5954: To amend title 38, United States Code, to provide veterans
            for presumptions of service connection for purposes of benefits
            under laws administered by Secretary of Veterans Affairs for
            diseases associated with service in the Armed Forces and
            exposure to biological, chemical, or other toxic agents as part
            of Project 112, and for other purposes.
        H.R. 5954 establishes a mechanism for determining presumptive
    service connections for diseases that could be related to participation
    in Project 112, which included an effort referred to as Project SHAD.
    The 2007 IOM report Long-Term Health Effects of Participation in
    Project SHAD (Shipboard Hazard and Defense), which was requested by the
    VA, found no clear evidence that specific long-term health effects were
    associated with participation in Project SHAD. The IOM study compared
    the health of veterans who participated in SHAD with the health of a
    similar group of veterans who did not participate. Although more SHAD
    veterans have died of heart disease, overall mortality rates among both
    groups of veterans were similar. Moreover, the differences in the rates
    of medical symptoms and conditions experienced by each group were
    generally slight, and the committee responsible for the report found no
    consistent, specific patterns of ill health among SHAD veterans.
    However, because of limitations in the study response rates and the
    size of the study, the report's findings should not be viewed as clear
    evidence that there are no possible long-term health effects related to
    SHAD involvement. Additionally, there have been very few hypotheses
    about specific health problems that could be related to the materials
    used in the SHAD tests to serve as a starting point for further
    investigation.
    H.R. 6032: To amend title 38, United States Code, to direct the
            Secretary of Veterans Affairs to provide wartime disability
            compensation for certain veterans with Parkinson's disease.
        The IOM has convened several committees under a mandate contained
    in the Agent Orange Act 1991 (Public Law 102-4), charged with
    evaluating the scientific evidence regarding associations between
    diseases and exposure to dioxin and other chemical compounds in
    herbicides applied during the Vietnam War. These committees have
    produced a series of reports on the topic, the most recent of which is
    Veterans and Agent Orange: Update 2006. Their work is supported under a
    contract with the VA.
        One health outcome examined in these reports is Parkinson's
    disease. The committee responsible for Update 2006 found that the
    evidence is inadequate or insufficient to determine whether there is or
    is not an association between Parkinson's disease and exposure to the
    herbicides used in Vietnam and their contaminants. Several studies have
    reported associations of Parkinson's disease with exposure to
    ``pesticides'' or to ``herbicides'' in general, but none yet reviewed
    have established a relationship with the specific herbicides sprayed in
    during the war. This condition continues to be of great interest to the
    committee and the latest research on the topic will be a subject of the
    next update, which will be released in 2009.
        The reports discussed here addressed a number of other topics
    related to veterans health and disability policy and also reached a
    series of other recommendations regarding these topics. The National
    Academies would be pleased to provide Members of the Subcommittee with
    hard copies of these reports upon request. The reports are also freely
    accessible online at the URLs listed in the references below.
        Thank you for the opportunity to present this testimony before the
    Subcommittee today. I would be happy to address any questions you may
    have.
    Institute of Medicine reports cited in this testimony
        A 21st century System for Evaluating Veterans for Disability
    Benefits. (2007). http://www.nap.edu/catalog.php?record_id=11885.
        Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific
    Literature. (2006). http://www.nap.edu/catalog.php?record_id=11757.
        Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine
    Bromide, Sarin, and Vaccines (2000). http://www.nap.edu/
    catalog.php?record_id=9953.
        Improving the Presumptive Disability Decision-Making Process for
    Veterans. (2008). http://www.nap.edu/catalog.php?record_id=11908.
        Long-Term Health Effects of Participation in Project SHAD
    (Shipboard Hazard and Defense). (2007). http://www.nap.edu/
    catalog.php?record_id=11900.
        PTSD Compensation and Military Service. (2007). http://www.nap.edu/
    catalog.php?record_id=11870.
        Veterans and Agent Orange: Update 2006. (2007). http://www.nap.edu/
    catalog.php?record_id=11906.

                Prepared Statement of Sidath Viranga Panangala,
           Analyst in Veterans Policy, Congressional Research Service
                              Library of Congress
    Introduction
        Chairman Hall, Ranking Member Lamborn, and Members of the
    Committee, my name is Sidath Panangala, from the Congressional Research
    Service (CRS). I am accompanied today by Christine Scott, Specialist in
    Social Policy, and Douglas Weimer, Legislative Attorney, also from CRS.
    We are honored to appear before the Committee. As requested by the
    Committee, my testimony will highlight major legislative milestones in
    the establishment of presumptions of service-connection for veterans'
    benefits. This is not an exhaustive list of legislation and regulations
    relating to the establishment of presumptions of service-connection.\1\
    CRS takes no position on any legislation that is under discussion
    today.
    ---------------------------------------------------------------------------
        \1\ For a detailed legislative and regulatory history of
    presumptions see the following: National Academy of Sciences, Institute
    of Medicine (IOM), Improving the Presumptive Disability Decision-Making
    Process for Veterans (2008); Zeglin, Donald, ``Presumptions of Service
    Connection'', paper prepared for the Veterans' Disability Benefits
    Commission (VDBC) (March, 2006); and Department of Veterans Affairs
    (VA), ``Analysis of Presumptions of Service Connection,'' a report to
    Senate Committee on Veterans' Affairs, December 23, 1993.
    ---------------------------------------------------------------------------
    Compensation for Service-Connected Disabilities
        In general, a veteran is entitled to compensation for disabilities
    incurred in or aggravated during active military, naval or air
    service.\2\ Currently, there are five ways to establish that a
    disability is service-connected:
    ---------------------------------------------------------------------------
        \2\ 38 U.S.C. Sec. 1110.

        1.  Through direct service-connection--that is, the facts, shown by
    evidence, establish that a particular injury or disease resulting in a
    disability was incurred while in service in the Armed Forces (38 CFR
    ---------------------------------------------------------------------------
    Sec. 3.303);

        2.  Through aggravation during service--that is, a preexisting
    injury or disease will be considered to have been aggravated while in
    service in the Armed Forces (38 CFR Sec. 3.306);

        3.  Through proximity--that is, a disability, which is proximately
    due to, or the result of a service-connected disease or injury which is
    considered to be service-connected (38 CFR Sec. 3.310). For example, a
    veteran developing cardiovascular disease due to a service-connected
    amputation of a lower limb.

        4.  Through a finding, the disability was caused by medical care or
    vocational rehabilitation provided by the Department of Veterans
    Affairs (VA)--Disabilities caused by VA provided medical care or
    vocational rehabilitation are treated as if they are service-connected
    (38 U.S.C. Sec. 1151).

        5.  Through the application of statutory presumptions--that is
    certain diseases as established by law or regulation are considered to
    have been incurred in or aggravated by service in the Armed Forces even
    though there is no evidence of such disease during the period of
    service (38 CFR Sec. 3.307);

        Today I will discuss the history of this fifth mechanism, the
    establishment of statutory presumptions.
    What is a Presumption?
        In the context of VA claims adjudication, a presumption could be
    seen as a procedure to relieve veterans of the burden to prove that a
    disability or illness was caused by a specific exposure that occurred
    during service in the Armed Forces. In other words, a presumption
    shifts the burden of proof concerning whether a disease or disability
    was caused or aggravated due to service, from the veteran to the VA.
    Often presumptions are applied to chronic diseases or illnesses that
    manifest after a period of time (sometimes many years) following
    service, and that may also occur in individuals who have never served.
    According to the VA's Analysis of Presumptions of Service Connection:

            Generally, a legal presumption is a procedural device that
            shifts the burden of proof by attaching certain consequences to
            the establishment of certain basic evidentiary facts. When the
            party invoking a presumption establishes the basic fact(s)
            giving rise to the presumption, the burden of proof shifts to
            the other party to prove nonexistence of the presumed fact. A
            presumption, as used in the law of evidence, is a direction
            that if fact A (e.g., manifestation within the specified period
            of a disease for which a presumption of service connection is
            available) is established, then fact B (service connection) may
            be taken as established, even where there is no specific
            evidence proving fact B (i.e., no medical evidence of a
            connection between the veteran's disease and the veteran's
            military service).\3\
    ---------------------------------------------------------------------------
        \3\ Department of Veterans Affairs (VA), ``Analysis of Presumptions
    of Service Connection'' a report to the Senate Committee on Veterans'
    Affairs, December 23, 1993, p. i.
    ---------------------------------------------------------------------------
    Legislative History of Presumptions
        The legislative history of veterans' disease presumptions dates
    back to 1921 when Congress, to ease the disability decisionmaking
    process in VA disability compensation adjudications, used its authority
    to establish service-connection on a presumptive basis. Given below is
    a synopsis of major legislation.
    1920s-1940s
        The first legislation that specifically established a presumption
    of service-connection was the amendment of August 9, 1921 (P.L. 67-47)
    to the War Risk Insurance Act (P.L. 63-193). This Act, among other
    things, established presumptions of service-connection for active
    pulmonary tuberculosis and neuropsychiatric disease (later known as
    psychosis) occurring within 2 years of separation from active duty
    military service. Prior to the passage of P.L. 67-47, disability
    compensation for World War I veterans was payable only for a disability
    directly related to military service. Broadly, the intent of this
    liberalization legislation was that ``as the period beginning with the
    end of the war lengthened it became increasingly difficult to establish
    service-connection for some ailments particularly tuberculosis and
    neuropsychiatric disease.'' \4\ The amendments to the War Risk
    Insurance Act also gave the then Veterans Bureau, authority to
    establish rules and regulations to carry out provisions in the Act.
    This allowed the agency to promulgate regulations establishing
    presumption of service-connection for certain diseases. As stated in
    VA's Analysis of Presumptions of Service Connection:
    ---------------------------------------------------------------------------
        \4\ U.S. Congress, House Committee on Veterans Affairs, The
    Provision of Federal Benefits for Veterans, An Historical Analysis of
    Major Veterans Legislation, 1862-1954, committee print, 84th Cong., 1st
    sess., House Committee Print No 171, December 28, 1955 (Washington:
    GPO, 1955), p. 21.

            Regulation No. 11 provided that chronic constitutional
            diseases, other than active pulmonary tuberculosis or
            neuropsychiatric disease, becoming manifest within 1 year
            following the date of separation from active service would be
            considered as incurred in service or aggravated by service
            unless there were affirmative evidence to the contrary or
            evidence establishing that some intercurrent disease or injury
            which is a recognized cause of the disorder was suffered
            between the date of separation from service and the onset of
            the chronic disease.\5\
    ---------------------------------------------------------------------------
        \5\ Department of Veterans Affairs (VA), ``Analysis of Presumptions
    of Service Connection,'' a report to Senate Committee on Veterans'
    Affairs, December 23, 1993, p. 10.

        The next major piece of legislation that established presumptions
    of service-connection was the World War Veterans Act of 1924 (P.L. 68-
    242) enacted on June 7, 1924. This Act made important changes to
    existing laws on presumptions related to tuberculosis and mental
    illness. Among other things, this Act added the following three
    diseases to the list of presumptive diseases: dysentery (amebic)
    (tropical disease added as chronic disease); paralysis agitans (now
    known as Parkinson's disease); encephalitis lethargica. Furthermore,
    this Act removed requirements that a veteran must show diagnosis by a
    medical examination conducted by a medical officer of the then Veterans
    Bureau or duly qualified physician within the presumptive period.
    ``This provision alone brought within the purview of the legislation
    thousands of veterans who [until then] had been unable to connect their
    disabilities with the service so as to be eligible for compensation and
    [medical care].'' \6\
    ---------------------------------------------------------------------------
        \6\ U.S. Congress, House Committee on Veterans Affairs, The
    Provision of Federal Benefits for Veterans, An Historical Analysis of
    Major Veterans Legislation, 1862-1954, Committee print, 84th Cong., 1st
    sess., House Committee Print No. 171, December 28, 1955 (Washington:
    GPO, 1955), p. 23.
    ---------------------------------------------------------------------------
        Between the passage of the World War Veterans Act of 1924 and P.L.
    80-748 several additions were made to the list of presumptive diseases
    through regulation and executive order. More significantly, the chronic
    disease category was significantly expanded through the enactment of
    P.L. 80-748 on June 24, 1948.
    1950s-1980s
        With the passage of the Veterans Benefits Act of 1957 (P.L. 85-56),
    Congress codified the existing list of presumptions and expanded this
    list by incorporating various presumptions of chronic diseases and
    disease categories that had been established by regulation and were in
    effect at that time. By the time P.L. 85-56 was enacted on June 17,
    1957, there were forty chronic diseases or disease categories and
    seventeen tropical diseases that were presumptively service-connected.
    The sixties did not see any significant legislative or regulatory
    changes affecting presumptions of service-connection.
        The next major legislative change occurred with the enactment of
    P.L. 91-376 in August 1970. This law established a presumption of
    service-connection for seven categories of diseases and conditions for
    any veteran held as a Prisoner of War (POW) in World War II, the Korean
    conflict, or the Vietnam War, and who suffered from dietary
    deficiencies, forced labor, or inhumane treatment in violation of the
    terms of the Geneva Conventions of July 27, 1929, and August 12, 1949.
        In August 1981, Congress passed the Former Prisoner of War Benefits
    Act of 1981 (P.L. 97-37). This Act, among other things, modified the
    list of statutory presumptions associated with POW status and also
    changed the presumptive period for eligibility. The Veterans'
    Compensation and Program Improvements Amendments of 1984 (P.L. 98-223);
    the Veterans' Benefits Improvements and Healthcare Authorization Act of
    1986 (P.L. 99-576); and the Veterans' Benefits and Services Act of 1988
    (P.L. 100-322) expanded the list of diseases in former POWs for which a
    presumption of service-connection was made. Prior to the passage of the
    Veterans' Healthcare, Training and Small Business Loan Act of 1981
    (P.L. 97-72), veterans who complained of Agent Orange-related illnesses
    were at the lowest priority for treatment at VA medical facilities
    because these conditions were not considered service-connected. P.L.
    97-72 elevated Vietnam veterans' priority status for healthcare at VA
    facilities by recognizing a veteran's own report of exposure as
    sufficient proof to receive medical care unless there was evidence to
    the contrary.
        After taking into consideration the ``apprehension and concern
    among some Vietnam veterans and their families . . . to the alleged
    ill-health effects among some Vietnam veterans . . . to exposure to the
    dioxin in Agent Orange,'' \7\ Congress passed the Veterans' Dioxin and
    Radiation Exposure Compensation Standards Act of 1984 (P.L. 98-542).
    The Act required the VA to develop regulations for disability
    compensation for Vietnam veterans exposed to Agent Orange.\8\ Veterans
    seeking compensation for a condition they thought to be related to
    herbicide exposure had to provide proof of a service-connection that
    established the link between the exposure and the disease onset. P.L.
    98-542 also authorized disability compensation payments to Vietnam
    veterans for the skin condition chloracne, which is associated with
    herbicide exposure. This law also established a program to provide
    disability compensation to radiation-exposed veterans who participated
    in the U.S. atmospheric atomic tests or in the U.S. occupation of
    Hiroshima and Nagasaki, Japan.
    ---------------------------------------------------------------------------
        \7\ U.S. Congress, House Committee on Veterans' Affairs, Veterans'
    Dioxin and Radiation Exposure Compensation Standards Act. Report to
    Accompany H.R. 1961, 98th Congress, 2nd sess., H.Rept. 98-592.
        \8\ Between 1962 and 1971, the U.S. Air Force sprayed approximately
    107 million pounds of herbicides in South Vietnam for the purpose of
    defoliation and crop destruction. The herbicides sprayed during the
    Vietnam era contained mixtures of 2,4-dichlorophenoxyacetic acid (2,4-
    D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and
    cacodylic acid. The most extensively used defoliant compound, a 50:50
    combination of 2,4-D and 2,4,5-T, came to be known as ``Agent Orange''
    because of the orange-colored band placed on each chemical storage
    container. For further information see CRS Report, RL34370, Veterans
    Affairs: Healthcare and Benefits for Veterans Exposed to Agent Orange,
    by Sidath Viranga Panangala.
    ---------------------------------------------------------------------------
        In response to atomic veterans' complaints about the difficulty of
    getting compensation under P.L. 98-542, Congress in 1988 enacted the
    Radiation-Exposed Veterans' Compensation Act (P.L. 100-321) which
    established a presumption of a service connection for 13 specified
    types of cancer. That list was subsequently expanded, first by
    legislation, later through VA administrative action, to 21 cancers.\9\
    ---------------------------------------------------------------------------
        \9\ For further information see CRS Report, RL33927, Selected
    Federal Compensation Programs for Physical Injury or Death, by Sarah A.
    Lister and C. Stephen Redhead.
    ---------------------------------------------------------------------------
    1990s-2000
        In 1991, the Agent Orange Act (P.L. 102-4) established for the
    first time a presumption of service connection for diseases associated
    with herbicide exposure. Under the Agent Orange Act, veterans seeking
    disability compensation for diseases they thought to be associated with
    herbicides no longer were required to provide proof of exposure. P.L.
    102-4 authorized the VA to contract with the Institute of Medicine
    (IOM) of the National Academy of Sciences (NAS) to conduct a scientific
    review of the evidence linking certain medical conditions to herbicide
    exposure. For the first time the Act established a new process
    establishing presumptive service-connection for illnesses related to
    herbicide exposure. According to an article published in the Journal of
    Law and Policy: ``The [IOM] process has become an essential step in
    ensuring that new service-connection presumptions command scientific
    credibility.'' \10\
    ---------------------------------------------------------------------------
        \10\ Brown, Mark, ``The Role of Science in Department of Veterans
    Affairs Disability Compensation Policies for Environmental and
    Occupational Illnesses and Injuries,'' Journal of Law and Policy, vol
    13, (2005).
    ---------------------------------------------------------------------------
        The Veterans' Radiation Exposure Amendments of 1992 (P.L. 102-578)
    amended P.L. 100-321 by adding two more cancers to the presumptive
    list. This was based on the ``Biological Effects of Ionizing Radiation
    V'' (BEIR V) report by the National Academy of Sciences (NAS).\11\ This
    law also repealed the disability compensation requirement that diseases
    suffered by radiation-exposed veterans must be manifested within 40
    years of exposure.
    ---------------------------------------------------------------------------
        \11\ Committee on the Biological Effects of Ionizing Radiation
    (BEIR), National Research Council, is part of the National Academy of
    Sciences.
    ---------------------------------------------------------------------------
        In November 1994, Congress enacted the Persian Gulf War Veterans'
    Benefits Act (P.L. 103-446), allowing the VA to pay compensation
    benefits to veterans for Gulf War-related disabilities caused by
    undiagnosed illnesses. This Act also codified VA's regulatory
    presumptions based on exposure to herbicides for these types of cancer:
    Hodgkin's disease, multiple myeloma, and respiratory cancers; and
    porphyria cutanea tarda, a metabolic disease (must occur within 1 year
    of exposure).
        In 1998, Congress enacted the Persian Gulf War Veterans Act of 1998
    (P.L. 105-277), and the Veterans Programs Enhancement Act 1998, (P.L.
    105-368). Similar to the Agent Orange presumptive program, these laws
    mandated regular and thorough reviews of the scientific and medical
    literature relevant to the health of Gulf War veterans by the IOM.
        The Veterans Education and Benefits Expansion Act of 2001 (P.L.
    107-103) expanded the definition of ``qualifying chronic disability''
    to include a ``medically unexplained chronic multisymptom illness (such
    as chronic fatigue syndrome, fibromyalgia, and irritable bowel
    syndrome) that is defined by a cluster of signs or symptoms.'' \12\
    Further more, the Veterans Benefits Act of 2003 (P.L. 108-183) provided
    a presumption of service-connection for cold weather injuries,
    traumatic arthritis, and certain psychiatric disabilities in former
    POWs, without regard to length of internment.
    ---------------------------------------------------------------------------
        \12\ Subsection 202 (a) of the Veterans Education and Benefits
    Expansion Act of 2001 (P.L. 107-103), December 27, 2001.
    ---------------------------------------------------------------------------
        With passage of the National Defense Authorization Act, FY2008
    (P.L. 110-181), Congress established a presumption of service-
    connection for purposes of VA medical care for any veteran of the
    Persian Gulf War who develops an active mental illness (other than
    psychosis) if such veteran develops such disability: (1) within 2 years
    after discharge or release from the active military, naval, or air
    service; and (2) before the end of the 2-year period beginning on the
    last day of the Persian Gulf War.\13\
    ---------------------------------------------------------------------------
        \13\ The term ``Persian Gulf War'' means the period beginning on
    August 2, 1990, and ending on the date thereafter prescribed by
    Presidential proclamation or by law (38 U.S.C. Sec. 101 (33)).
    ---------------------------------------------------------------------------
    Institute of Medicine Study on Presumptive Disability Decision-Making
        Since an ``increasing proportion of service-connected disability
    compensation is paid through a presumptive decisionmaking process,''
    \14\ the Veterans' Disability Benefits Commission (VDBC) in 2006,
    requested the IOM, to provide a framework on how future presumptions
    should be made based on scientific principles.\15\ In 2007, the IOM
    made several recommendations--which the VDBC generally endorsed--which
    would, among other things, create an advisory Committee and a
    scientific review board. The advisory Committee ``would consider, and
    give priority to the exposures and health conditions proposed for
    possible presumptive evaluation'' while the ``science review board, an
    independent body, would evaluate the strength of the evidence (based on
    causation) that links a health condition to a military exposure.'' \16\
    Next, the independent science review board's report and recommendations
    would go to VA for its consideration and implementation.\17\
    ---------------------------------------------------------------------------
        \14\ Honoring the Call to Duty: Veterans' Disability Benefits in
    the 21st Century, Report of the Veterans Disability Benefits
    Commission, (October 2007), p. 153. The Commission was established by
    the National Defense Authorization Act for FY2004 (P.L. 108-136).
        \15\ Ibid. p. 17.
        \16\ National Academy of Sciences, the Institute of Medicine (IOM),
    Improving the Presumptive Disability Decision-Making Process for
    Veterans (2008), p. 3.
        \17\ Ibid. p.18.
    ---------------------------------------------------------------------------
    Conclusion
        Since 1921, Congress has established numerous presumptions of
    service connection for a variety of health conditions affecting
    veterans. In establishing these presumptions, Congress and others have
    sought to balance the dual obligations of the VA, to provide care for
    veterans who were harmed by their service, and to do so in a manner
    that is equitable, scientifically sound, and accountable.

                       Prepared Statement of Les Jackson,
                Executive Director, American Ex-Prisoners of War

        Chairman Hall, Distinguished Members of the Subcommittee on
    Disability Assistance & Memorial Affairs, and Guests. Thank you for
    inviting us to participate in your legislative hearings on several
    bills now pending in the House Committee on Veterans Affairs. We will
    confine our remarks to H.R. 1197 Improved Veterans' Benefits for Former
    Prisoners of War.
        Ninety nine percent of former Prisoners of War are from WWII and
    Korea and are now living in their sunset years. We are grateful that
    Congress has through the years provided benefits for former Prisoners
    of War where it has been determined that the causal effect of an injury
    or illness is from the captive experience.
        For more than 50 years the National Academy of Sciences has been
    conducting scientific research to identify medical conditions that,
    beyond any doubt, are the direct consequences of the brutal conditions
    of captivity.
        There are two medical conditions cited that still deserve
    presumptive status. These are osteoporosis and diabetes. Osteoporosis
    is bone loss attributed to starvation during captivity. Similarly,
    diabetes is the result of prolonged stress and permanent damage to the
    body's basic defense system as a result of months and years of grossly
    inadequate diet as a Prisoner of War.
        These two proposed presumptives have again been introduced by
    Representative Gus Bilirakis (R-FL). We are deeply thankful to him and
    strongly urge your committee's support by codifying these two
    conditions into law without further delay.
        Also, very important to former Prisoners of War and their survivors
    is H.R. 156, to amend 38, U.S. Code, to provide for the payment of DIC
    to survivors of former POWs who died before September 30, 1999, with
    the same eligibility as applied to payment of DIC to Survivors of
    former POWs who die after that date. This will be of great financial
    aid to the surviving spouses of POWs. Thank you.

                     Prepared Statement of Steve Smithson,
        Deputy Director, Veterans Affairs and Rehabilitation Commission,
                                American Legion

        Mr. Chairman and Members of the Subcommittee:
        Thank you for this opportunity to present The American Legion's
    views on the bills being considered by the Subcommittee today. The
    American Legion commends the Subcommittee for holding this hearing.
    H.R. 1197, Prisoner of War Benefits Act of 2007
        The purpose of this bill is to amend title 38, United States Code,
    (U.S.C.) to provide improved benefits for veterans who are former
    prisoners of war.
        Specifically, this bill would repeal the current requirement in
    title 38 U.S.C. that an individual had to have been detained or
    interned for a period of not less than 30 days in order to be entitled
    to presumptive service connection for certain Prisoner of War (POW)
    diseases. It would also expand the list of POW diseases presumed to be
    service-connected, currently set forth in title 38, U.S.C., section
    1112(b), to include diabetes type 2 and osteoporosis. The legislation
    would also specifically authorize the Secretary of Veterans Affairs to
    create regulations adding or deleting diseases enumerated in section
    1112(b), on the basis of sound medical and scientific evidence, to
    include recommendations from The Department of Veterans Affairs' (VA's)
    Advisory Committee on Former Prisoners of War.
        The issue of the welfare and well-being of those veterans who have
    endured the hardship and trauma of being held as a POW has long been
    one of the major concerns of The American Legion. To ensure that the
    government of the United States fulfills its obligation to these brave
    men and women, The American Legion has actively supported improvements
    in benefits provided to these individuals and their survivors. We are
    pleased to support the addition of the two conditions, specified in
    this bill, to the list of those currently presumed to be service-
    connected. It is hoped this legislation will provide the impetus for
    continuing action to further broaden the list of presumptive diseases
    and disabilities, from which former POWs are known to suffer. Toward
    this end, we are encouraged that the bill recognizes and emphasizes the
    important role played by VA's Advisory Committee on Former Prisoners of
    War. This group of esteemed individuals, many of who, are themselves
    former POWs, provide the necessary mechanism and forum to evaluate
    scientific and medical studies on former POWs to make appropriate
    recommendations to the Secretary regarding needed changes in VA's
    outreach, benefits, and medical care program for this community of
    veterans.
        Additionally, The American Legion has long supported the
    elimination of the arbitrary 30-day requirement for internment. Studies
    have shown there can be long-lasting, adverse health effects resulting
    from even a relatively short period of confinement as a prisoner of
    war. Such findings are especially important considering the nature of
    today's warfare and the rather short period of confinement most
    American POWs have faced during the post-Vietnam era.
        This legislation represents a solid step toward ensuring former
    POWs receive the compensation and medical care to which they are
    clearly entitled. However, in addition to those diseases that would be
    presumed service-connected, The American Legion recommends that the
    list also include chronic pulmonary disease, where there is a history
    of forced labor in mines during captivity, and generalized
    osteoarthritis, as differentiated from the currently listed disability
    of post traumatic osteoarthritis.
    H.R. 3008, Rural Veterans Services Outreach and Training Act
        The purpose of this bill is to amend title 38, U.S.C., to improve
    services for veterans residing in rural areas. Specifically, this bill
    would establish a competitive grant program to provide financial
    assistance to state entities for veterans' affairs for the training of
    rural county veteran service officers in order to improve outreach and
    assistance to veterans, their spouses, children and parents, who may be
    eligible to receive benefits under the laws administered by the
    Secretary of Veterans Affairs, and to ensure that such individuals are
    fully informed about, and assisted in applying for, any benefits and
    programs under such laws.
        Providing proper outreach and assistance to the Nation's veterans,
    has been, and will continue to be, a top priority of The American
    Legion. Although we do not have an official position, in the form of a
    resolution adopted by our membership, specifically addressing a grant
    program for such purposes, as proposed in this legislation, we would
    not oppose the Committee's favorable consideration of this bill.
    H.R. 3070, Disabled Veterans' Caregiver Compensation Act
        The purpose of this bill is to amend title 38, U.S.C., to authorize
    additional compensation to be paid to certain veterans in receipt of
    compensation for a service-connected disability rated totally disabling
    for whom a family member dependent on the veteran for support provides
    care.
        As written, this bill would provide additional compensation in the
    amount of $234 per month to totally disabled service-connected veterans
    in need of regular aid and attendance only where the veteran is being
    taken care of by an adult family member who is dependent upon the
    veteran for support. It should be noted that veterans who are
    permanently disabled and in need of aid and attendance already receive
    an additional $618 per month (SMC L pays $3,145) over the 100-percent
    rate ($2,527). Therefore, this bill will raise the monthly benefit
    amount for this subset of veterans from $3,145 to $3,379.
        The additional money paid to veterans, who need aid and attendance,
    is intended, in part, to help veterans who require aid and attendance
    to hire people who could provide care. Obviously, this bill
    contemplates that the veteran could use the additional $234 to
    compensate the adult family member who is taking care of the veteran.
    It is unclear why this additional amount would be provided as separate
    from the regular aid and attendance benefit because the purpose of the
    aid and attendance benefit is to pay for such care as addressed in this
    bill. It is also unclear as to how VA will determine who qualifies as a
    family member dependent on the veteran for support. This being the
    case, The American Legion would support an increase in the overall aid
    and attendance benefit rather than a separate payment as set forth in
    this bill.
    H.R. 3795, You Were There, You Get Care Act of 2007
        The purpose of this bill is to amend title 38, U.S.C., to provide
    that veterans of service in the 1991 Persian Gulf War and subsequent
    conflicts shall be considered to be radiation-exposed veterans for the
    purposes of the service connection of certain diseases and
    disabilities, and for other purposes.
        Depleted Uranium (DU) munitions were widely used in the Southwest
    Asia theater of operations during the 1991 Gulf War and have been used
    extensively in military operations since then, including the current
    conflicts in Iraq and Afghanistan. As a result, there have been
    thousands of military personnel exposed to DU fallout from these
    munitions, including some with retained shell fragments due to
    ``friendly fire'' incidents. The American Legion supports the intent of
    this bill. The American Legion recognizes the potentially harmful
    effect of DU exposure. This legislation would provide for the
    presumption of service connection for diseases associated with such
    exposure for those suffering from such a disease who served in the 1991
    Gulf War and any subsequent conflict where DU munitions were used. This
    legislation would also include service in the theater of operations of
    that war or conflict or involved the clean-up or servicing of vehicles
    or equipment that had been used in such a theater of operations.
    H.R. 4274, Gold Star Parents Annuity Act of 2007
        The purpose of this bill is to amend title 38, U.S.C., to provide
    for the payment of a monthly stipend to the surviving parents (known as
    Gold Star parents) of members of the Armed Forces who die during a
    period of war.
        The American Legion does not have a position on this legislation.
    H.R. 5155, Combat Veterans Debt Elimination Act of 2008
        The purpose of this bill is to amend title 38, U.S.C., to prohibit
    the Secretary of Veterans Affairs from collecting certain debts to the
    United States in the case of veterans who die as a result of a service-
    connected disability incurred or aggravated on active duty in a combat
    zone, and for other purposes.
        Although we agree with the intent of this bill, the legislation
    contains limitations and restrictions we do not support. The American
    Legion supports prohibiting the collection of debts in the case of any
    veteran who dies as a result of a service-connected disability, not
    just those who die of a service-connected disability incurred or
    aggravated while serving in a theater of combat operations or in combat
    against a hostile force during a period of hostilities.
        A veteran's death due to a service-connected disability not related
    to combat is no less tragic for the veteran's family than a death due
    to a combat-related service-connected condition and we see no
    justification in making such a distinction. This bill also leaves it up
    to the discretion of the VA Secretary to determine if termination of
    collection of the debt is in the best interest of the United States and
    does not set forth any standards or criteria that must be met in
    determining whether or not termination of collection is in the best
    interest of the United States.
        Unfortunately, such vagueness will likely result in a restrictive
    interpretation which will, in turn, limit the beneficial impact that
    was obviously intended. The American Legion also has concerns over the
    exclusion of debts involving housing and small business benefit
    programs from the prohibition of collection.
    H.R. 5448, Full Faith in Veterans Act of 2008
        The purpose of this bill is to amend title 38, U.S.C., to improve
    the disability compensation evaluation procedure of the Secretary of
    Veterans Affairs for veterans with post traumatic stress disorder, to
    improve the diagnosis and treatment of post traumatic stress disorder
    by the VA Secretary, and for other purposes.
        The American Legion supports the intent of this bill to correct
    current deficiencies in the service connection and evaluation of post
    traumatic stress disorder.
    H.R. 5454
        The purpose of this bill is to amend title 38, U.S.C., to establish
    a presumption of service connection for amyotrophic lateral sclerosis
    (ALS) for the purpose of the laws administered by the VA Secretary.
        ALS is an insidious disease involving degeneration of the nerve
    cells in the brain, the brain stem, or spinal cord. ALS is
    characterized by atrophy and almost always fibrillation of the muscular
    system of the body. Although the disease was first identified in 1869,
    we still do not know what causes it or how it can be prevented,
    effectively treated or cured. ALS in its primary stage is difficult, if
    not impossible, to diagnose since in this stage the condition may
    appear to be dormant with little or no progression of symptoms for many
    years, thus leading the individual and his or her doctor to believe the
    condition has become arrested and nothing more is done to establish its
    diagnostic entity.
        Specifically, this bill, if enacted, would eliminate the 1-year
    delimiting period currently in place for the presumptive service
    connection of ALS, allowing for the presumptive service connection of
    ALS for veterans diagnosed with the disease anytime after military
    service. The American Legion fully supports this legislation. In fact,
    we have formally voiced our concerns over the inadequacy of the current
    1 year presumptive period for many years.
        The timeliness and appropriateness of this bill is further
    supported by research in the last several years that has indicated that
    those who have served in the military are at greater risk of developing
    ALS than those who never served in the military. Moreover, the
    Institute of Medicine, in a November 2006 report entitled Amyotrophic
    Lateral Sclerosis in Veterans: Review of the Scientific Literature,
    concluded that current scientific evidence supports the increased risk
    of ALS in military veterans.
    H.R. 5709, Veterans Disability Fairness Act
        The purpose of this bill is to amend title 38, U.S.C., to require
    the VA Secretary to carry out quality assurance activities with respect
    to the administration of disability compensation, and for other
    purposes.
        The American Legion supports this bill.
    H.R. 5954
        The purpose of this bill is to amend title 38, U.S.C., to provide
    veterans for the presumptions of service connection for purposes of
    benefits under the laws administered by the VA Secretary for diseases
    associated with service in the Armed Forces and exposure to biological,
    chemical, or other toxic agents as part of Project 112, and for other
    purposes.
        The American Legion fully supports this bill as it would put in
    place the process for establishing presumption of service connection
    for diseases that have been scientifically associated with exposure to
    the various agents and chemicals used in Project 112.
    H.R. 5985, Compensation for Combat Veterans Act
        The purpose of this bill is to amend title 38, U.S.C., to clarify
    the service treatable as service engaged in combat with the enemy for
    utilization of non-official evidence for proof of service connection in
    a combat-related disease or injury.
        A bill with a similar intent (H.R. 5892) was recently passed by
    this Committee. Both Title I of H.R. 5892 and this bill seek to define
    ``engaged in combat with the enemy,'' under title 38 U.S.C. section
    1154(b), in a manner that it is consistent with the realities of combat
    in today's world.
        The American Legion supports the intent of these bills. Unless a
    veteran was wounded or received a specific combat decoration or badge
    (such as the Combat Infantryman Badge or Combat Action Ribbon) or award
    for valor, it is often very difficult to establish that a veteran
    engaged in combat with the enemy in order to trigger the combat
    presumptions under title 38, U.S.C., section 1154(b). We must
    recognize, however, that the very meaning of the term ``engaged in
    combat with the enemy'' has taken on a whole new meaning as the nature
    of warfare in today's world has changed. This is especially true of
    service in the combat theaters of Iraq and Afghanistan.
        Due to the fluidity of the battlefield and the nature of the
    enemy's tactics, there is no defined frontline or rear (safe) area.
    Military personnel in non-combat occupations and support roles are
    subjected to enemy attacks such as mortar fire, sniper fire, and
    improvised explosive devices (IEDs) just as their counterparts in
    combat arms-related occupational fields. Unfortunately, such incidents
    are rarely documented making them extremely difficult to verify.
        Servicemembers who received a combat-related badge or award for
    valor automatically trigger the combat-related presumptions of title
    38, U.S.C., section 1154(b), but a clerk riding in a Humvee, who
    witnessed the carnage of an IED attack on that convoy, doesn't
    automatically trigger such a presumption and proving that the incident
    happened or that he or she was involved in the incident, in order to
    benefit from the presumption afforded under title 38, U.S.C., section
    1154(b), can be extremely time consuming and difficult.
        Given the evolving nature of modern warfare, as reflected in the
    enemy's unconventional tactics in Iraq and Afghanistan, The American
    Legion is of the opinion that it not only makes sense to clarify the
    definition of ``engaged in combat with the enemy'' under title 38,
    U.S.C. section 1154(b) in order to adapt to the new realities of modern
    warfare. It is essential that we do so, not just for those serving now,
    but for those who have served in the past and those who will serve in
    the future.
    H.R. 6032
        The purpose of this bill is to amend title 38, U.S.C., to direct
    the VA Secretary to provide wartime disability compensation for certain
    veterans with Parkinson's disease.
        Specifically, this bill, if enacted, would establish Parkinson's
    Disease as a presumptive disability associated with Agent Orange/
    herbicide exposure in Vietnam. The American Legion strongly supports
    the addition to the presumptive list all conditions that have been
    scientifically shown to be associated with Agent Orange/herbicide
    exposure in accordance with provisions set forth in statute.
        If Parkinson's Disease does not satisfy such criteria at this time,
    The American Legion recommends further research to explore the
    relationship between Parkinson's Disease and exposure to herbicides.
                                   Conclusion
        Thank you again, Mr. Chairman, for allowing The American Legion to
    present comments on these important bills. As always, The American
    Legion welcomes the opportunity to work closely with you and your
    colleagues on enactment of legislation in the best interest of
    America's veterans and their families.

                       Prepared Statement of John Rowan,
                National President, Vietnam Veterans of America

        Good morning, Chairman Hall, Ranking Member Lamborn, and other
    Members of this distinguished Subcommittee. On behalf of the members of
    Vietnam Veterans of America (VVA), we thank you for the opportunity to
    appear here today to share our views on several of the bills up for
    consideration. We ask that our full statement be entered in the record,
    and I will briefly summarize the most salient points of our statement.
        We'd like to begin with H.R. 5954, which would provide veterans for
    presumptions of service connection for purposes of benefits for
    diseases associated with service in the Armed Forces and exposure to
    biological, chemical, or other toxic agents as part of Project 112.
        We think some background is relevant here. Some 7 years ago, VVA
    first learned of the then top-secret tests done at the height of the
    Cold War under the rubric of Project 112. These included the SHAD tests
    conducted mostly in the waters of the South Pacific as well as on land
    in Alaska, Hawaii, and several other venues in the United States and
    Canada; these tests were designed to measure the lethality of
    biological agents and simulants for agents, e.g., bacillus globigii for
    bacillus anthraxis, and the ability of U.S. vessels to repel them. They
    also included tests of hallucinogens and other pharmacological agents,
    mostly but not exclusively at Edgewood Arsenal and Fort Detrick. In the
    former tests, sailors and other military personnel were participants,
    not test subjects; in the latter tests, military personnel were very
    definitely the test subjects. Some tests, like the SHAD tests,
    commenced under Project 112; others, particularly the testing at
    Edgewood and Detrick, began as far back as 1952.
        Thanks to the efforts of Navy veterans like Jack Alderson of
    California, and John Olsen of Montana, and Norman LaChapelle of
    Tennessee (although he wasn't always from there), VVA became very
    interested in the possible long-term health effects of exposure to the
    agents and simulants that had been tested and the chemical
    decontaminants that had been used to ``clean'' ships and tugs after a
    test, or individual trials in a test, were completed. When we first
    approached the Department of Defense, we were stonewalled; eventually,
    DoD owned up to having planned some 134 SHAD tests and having completed
    50 of them. We never learned as much as we would have liked to learn
    about the Edgewood and Detrick tests, in part because of the
    composition of our Task Force on Project 112/SHAD, which was heavily
    weighted with SHAD veterans.
        We applauded Congressmen Mike Thompson and Denny Rehberg when they
    introduced H.R. 4952 in the 109th Congress. We applaud them again for
    introducing H.R. 5954 in this Congress. We endorse H.R. 5954, but with
    these caveats:

          Because chemical and biological agents are not
    necessarily toxic, language concerning exposure to ``a biological,
    chemical, or other toxic agent . . .'' is not quite correct. Also, if
    pharmacological products and hallucinogens are not embraced under
    ``biological agents,'' they must be specified at the risk of
    inadvertently eliminating from the pool of veterans covered by this act
    several thousand veterans who were in fact test subjects.

          By essentially covering veterans who served from
    ``approximately 1963,'' those who participated in tests prior to that
    year also would not be covered. This would be a miscarriage of justice,
    inasmuch as testing conducted during the fifties was subsumed under
    ``112'' when Secretary of Defense McNamara divvied up the functions of
    the Department of Defense into some 150 different functions. Covering
    these veterans does not represent a ``fishing expedition.'' DoD is now
    maintaining a registry of Project 112 veterans (as well as registries
    of veterans who participated in lewisite and mustard gas testing during
    World War II, and veterans who were part of any other tests of chem-bio
    agents not embraced under Project 112).

        VVA supports H.R. 5954, with the noted caveats, because it
    represents a simple measure of justice. Veterans whose health has been
    adversely affected by exposures during their military service warrant
    healthcare and compensation for conditions shown to be positively
    associated with such exposures.
        H.R. 1197, The Prisoner of War Benefits Act of 2007, would repeal
    the currently required 30-day minimum period of internment prior to the
    presumption of service connection for certain diseases for purposes of
    the payment of veterans' disability compensation; it would add diabetes
    (type 2) and osteoporosis to the diseases already covered.
        As with H.R. 5954, veterans (in this case former POWs) would be
    covered ``whenever the Secretary [of Veterans Affairs] determines, on
    the basis of sound medical and scientific evidence, that a positive
    association exists'' between an experience of military service and the
    occurrence of a disease in humans. This of course assumes that the
    Secretary of Veterans Affairs and that bureaucratic structure,
    including the notoriously anti-veteran bureaucrat's bureaucracy of
    Office of Management & Budget (OMB), will act in a fair and impartial
    manner. Often, nothing approximating veteran-friendly or even
    impartiality is evident. In fact the opposite is more often than not
    the case.
        The flaw in the scenario of looking to the scientific evidence is
    that quite often the government will not fund the needed research, and
    all too often there is no reason for others to provide the resources to
    do such research, so the veteran is left bereft as the government
    either will not give the veteran access to key information citing
    ``national security'' when in fact it is only the desire to escape
    culpability for damage done to the long term healthcare of veterans, or
    they will not fund the research needed to prove the case one way or
    another.
        VVA endorses H.R. 1197, even though we recognize that it may be
    difficult to secure passage because of ``PAYGO'' rules, unless an
    appropriate offset can be found. Frankly, the Secretary of Veterans
    Affairs should immediately seek a full review by the Institute of
    Medicine (IOM) reading Parkinson's disease. If it turns out that there
    is too little epidemiological evidence regarding veterans as determined
    by IOM then the Secretary should be bound to fund such independently
    conducted research as to be able to provide sufficient evidence that
    will indicate whether there is evidence of statistical association or
    not.
        H.R. 3008, the Rural Veterans Services Outreach and Training Act,
    would direct the Secretary of Veterans Affairs to carry out a program
    to make competitive grants to provide financial assistance to state
    departments of veterans affairs for the training of rural county
    veteran service officers in order to improve outreach and assistance to
    veterans, as well as their spouses, children, and parents, who may be
    eligible to receive veterans' or veterans-related benefits and who are
    residing in rural counties.
        It is difficult to disagree with the goals of this legislation.
    However, before VVA can support H.R. 3008, it needs a bit of tweaking.
        Veterans service organizations, too, supply veteran service
    officers to assist veterans and their dependents and survivors in
    filing claims with the Veterans Benefits Administration. Should not the
    VSOs, too, therefore, benefit from the largesse of this act? To direct
    grants of up to $1 million annually exclusively to and for county
    veteran service officers does a disservice to organizations like VVA,
    DAV, VFW, and the American Legion who provide effective representation
    to veterans.
        Another weakness of this bill is that it does not recognize the
    reality that some state and county service officers do not provide
    representation before the Board of Veterans' Appeals, and other
    organizations, e.g., VSOs, will not take on the cases of veterans in
    the appeals stage. BVA representation ought to be mandatory for a
    county's application for funding to be granted should this bill be
    enacted.
        We must also quibble with the definition of a county veteran
    service officer. What is missing from this definition is that (s)he
    must be accredited by the VA. Without this proviso, the law opens up
    the possibility that uncertified service officers can be trained and
    employed who do not meet VA requirements.
        Last, there must be some sort of quality assurance and
    accountability mechanisms built into this bill to ensure that what is
    really needed--high quality representation by trained and dedicated
    individuals who will help veterans residing in rural areas know the
    benefits to which they are entitled and skilled help in receiving those
    benefits--is actually the outcome that this proposed program is likely
    to achieve.
        If modified to meet the above criteria, then VVA would endorse such
    a bill.
        VVA applauds the impetus behind proposals such as this as the shape
    of our current active duty force is the most rural we have had in a
    century. Almost 40 percent of this active duty force (including
    deployed National Guard and Reservists) come from towns of 25,000 or
    less, according to DoD sources. Therefore, we (collectively) must
    rethink the paradigm of the way in which we deliver veterans' benefits
    and services of all types, whether it be the size and location of
    national cemeteries, or medical care, or assistance in learning about
    and securing hard earned veterans' entitlements and services.
        H.R. 3070, The Disabled Veterans' Caregiver Compensation Act, would
    require the Secretary of Veterans Affairs to pay monthly compensation
    of $234 to a veteran if and while totally disabled and in need of
    regular aid and attendance and while unpaid aid and attendance is
    provided by an adult family member who is dependent upon such veteran
    for support.
        VVA's only question is: Why $234? Where did this figure come from?
    Is it subject to annual COLA increases? Despite these questions, VVA
    does support enactment of H.R. 3070, although we think that this
    monthly amount is ridiculously low, and demeans the quality of care now
    given by adult family members, and does not even begin to make up for
    income lost when a spouse or parent or other quits work or takes only
    part time work in order to have the time to care for the veteran.
        H.R. 3795, The You Were There, You Get Care Act of 2007, presumes
    specified diseases, and any other disease found by the Secretary of
    Veterans Affairs to result from exposure to depleted uranium or the
    byproducts of the burn-off that occurs when a depleted uranium munition
    penetrates a target, among those diseases that will be presumed to be
    service-connected (and therefore compensable) when appearing in
    radiation-exposed veterans.
        Perhaps the critical element in this bill is the provision for
    independent medical study to determine diseases that may result from
    exposure to depleted uranium. If, as is the case with dioxin, there is
    compelling medical and scientific evidence that points to a positive
    association between exposure and the onset of a particular disease,
    then an exposed veteran surely warrants care and treatment and
    compensation. If enactment of this bill leads to greater knowledge
    about the potential health effects of exposure to depleted uranium, if
    it can clear up some of the controversies over the claimed adverse
    health effects of exposure, then it is worth the time of Congress to
    enact it.
        Keep in mind, however, that depleted uranium has been in production
    since the late sixties and has been tested in weaponry at such places
    at the Davy Crockett range in Hawaii. Is it fair to troops who may have
    been exposed to DU in these tests not to be covered for possible harm
    incurred during their service?
        VVA supports H.R. 3795, but recommends expanding the group of
    veterans to include all who were potentially exposed, including those
    involved in testing this weapon.
        H.R. 4274, The Gold Star Parents Annuity Act of 2007, would direct
    the Secretary of Defense to pay a special pension to each person who
    has received a Gold Star lapel button as a parent of a member of the
    Armed Forces who died while serving.
        VVA has long supported a pension for Gold Star Mothers who, in
    their old age, we would like to believe would have been assisted by
    their son or daughter had (s)he not died during a period of war or
    afterward because of illness or injuries incurred during military
    service. Frankly, however, the starting point for date of death should
    be retroactive to at least include the parents of those killed in
    Vietnam, even though the payments would only begin from the date of
    enactment forward.
        VVA at every level, local, state, and national, has a great deal of
    contact with these wonderful people, many of whom are active in
    American Gold Star Mothers organization. Many of them are clearly
    struggling today. We would suggest that a further modification of the
    proposed legislation be made so that such payments would not begin
    until at least age 50, unless the individual recipient can show an
    extreme hardship.
        VVA also strongly urges the Committee to take action to end the
    ``widows tax,'' and to work with your colleagues in other Committees of
    the Congress to stop the shameful action of offsetting Dependency &
    Indemnity Compensation (DIC) at VA by the amounts received under the
    Survivor's Benefits Program (SBP) at DoD. The current ``offset'' is
    akin to reducing the amount of DIC because the servicemember had a life
    insurance annuity with Metropolitan Life or some other private
    insurance company. They paid premiums into the SBP for many years, and
    so it a paid for benefit, and it is outrageous to deduct that amount
    from the DIC. It is nothing short of an unjust ``widows tax.'' It is
    way past time to rectify this injustice.
        Additionally, VVA has testified many times about the crying need to
    increase the amount of monthly payments under DIC. It is simply an
    egregiously paltry amount that is paid to these dependents, and leaves
    many Gold Star Wives below the poverty level. This is simply just not
    right nor just. The founding principle of veterans' benefits is ``To
    Care for Him who hath borne the battle, and for his widow and orphan''
    in the great phrase of President Abraham Lincoln. Frankly, we are just
    not living up to our obligation in this regard, and DIC must be
    significantly increased as soon as possible.
        VVA applauds the motivation of Congressman Walsh and this
    distinguished body, but believes that it is the older parents who are
    in most dire need today, and deserve to be included as a priority.
    Further, the significant and valid needs of the surviving spouses must
    be addressed with at least as much urgency as the significant and valid
    needs of the older Gold Star parents.
        H.R. 5155, The Combat Veterans Debt Elimination Act of 2008, would
    prohibit the Secretary of Veterans Affairs from collecting certain
    debts owed to the government by any veteran who dies as a result of a
    service-connected disability incurred or aggravated while serving in a
    theater of combat operations in a war after the Persian Gulf War or in
    combat against a hostile force after September 11, 2001, if the
    Secretary determines that the termination of collection is in the best
    interests of the United States.
        It is hard not to endorse this bill. One quibble that is perhaps
    little more than theoretical: What if a veteran who owes the government
    money is called back into service, or chooses to reenlist, and then
    dies in a combat theatre of operations before a claim for a service-
    connected disability has been adjudicated by the VA? VVA believes that
    debt should be negated if he or she died in the line of duty, and not
    passed on to the veteran's survivors.
        VVA also believes that given the disaster that has been made of the
    system of adjudicating claims that it is way past time to end the
    current rule of ``the claim dies with the veteran.'' VVA recommends
    that if a veteran dies, and a claim has been pending for more than 90
    days, that said claim automatically be turned into a DIC claim for the
    survivor(s), and that when finally settled, that if such a claim is
    successful that full benefits up until the hour of death be paid, and
    that the payments for DIC begin at that moment retroactively.
        The veteran and their family should not be penalized for the poor
    leadership and stewardship of the system that is supposed to adjudicate
    veterans' claims, for, as General Bradley was fond of saying when he
    led the VA: ``we are here to meet the veteran's needs, not our
    bureaucratic needs.''
        H.R. 5448, The Full Faith in Veterans Act of 2008, would direct the
    Secretary of Veterans Affairs to accept as sufficient proof of service-
    connection of post traumatic stress disorder (PTSD) alleged to have
    been incurred in or aggravated by active military service a diagnosis
    of PTSD by a mental health professional, together with a written
    determination that such PTSD is related to the veteran's service, if
    consistent with the circumstances, conditions, or hardships of such
    service, notwithstanding that there is no official record of such
    incurrence or aggravation during such service.
        With all the focus on PTSD these days--Is the VA refusing in at
    least some locations to diagnose PTSD in cases to somehow save money?
    (VVA thinks this may be the case, as events at Temple VAMC in Texas
    have shown recently). Is there a battalion of ``shirkers'' out there
    who will fake symptoms in order to get some free money? (VVA has good
    reason to believe this to be a fevered delusion of one notorious
    ``scientist'' who never has any real data, but who shouts out this
    garbage nonetheless.) does address some pressing and timely issues. It
    does, however, have certain flaws.
        Part of the purpose of H.R. 5448 is ``to improve the diagnosis and
    treatment of post traumatic stress disorder by the Secretary of
    Veterans Affairs.'' Well, Dr. Peake neither diagnoses nor treats
    personally, but more importantly, this bill has nothing to do with
    diagnosis and treatment; rather, it is about service-connection. Also,
    while this bill addresses PTSD, it neglects other mental disabilities
    linked to one's military service, which may also (and often is)
    directly linked to military service, particularly in dangerous
    situations.
        Furthermore, as evidence in support of this bill, VVA reminds the
    Committee that the Doherwend, et al. study published in August of 2006
    that revisited the National Vietnam Veterans Readjustment Study (NVVRS)
    went back to all who claimed exposure to traumatic events in that 1986
    survey/study. The researchers then tried through searching unit
    histories, after-action reports, newspaper and other news coverage, and
    other sources and tried to objectively show that the violent event did
    occur at the time and place self-reported by the veteran. What they
    found was that 91 percent of the claims could be verified as having
    occurred, at least there was written or printed materials that
    substantiated the veterans' professed exposure was either proven, was
    shown to be likely, or was at least proven to be plausible. Insofar as
    the other 10 percent or so of claims of traumatic events, the
    researchers stressed the fact that they could not find any
    substantiating records certainly did not mean that the event self-
    reported by the veteran did not occur. War is by its very nature messy
    and confusing, and often things happen that are not fully recorded,
    even though neat and tidy documentation is supposed to always happen
    according to the military's bureaucracy. Those of us who have been in a
    war zone know that the reality is often different.
        Further, the VA Office of the Inspector General Report No. 05-
    00765-137, ``Review of State Variances in VA Disability Compensation
    Payments'' randomly sampled about 2,300 claims folders that had been
    adjudicated as being 100 percent for PTSD (many were 100 percent only
    when combined with individual unemployability) from a number of VA
    Regional Offices, in both large states and rural states. After a
    protracted uproar regarding charges by the OIG in press statements
    alleging fraud, the 2,300 files were sent to the Office of the
    Undersecretary for Veterans Benefits. He assembled a team that went
    through each claim carefully to weigh the evidence, and thoroughly
    asses each case. Out of the roughly 2,300, only two were found to merit
    full scale investigation by the IG, and these two were forwarded back
    to IG to further investigate. Ultimately the IG found that there were
    significant errors made in these two cases, but could not find any
    evidence of fraud or intent to fraud.
        This stands as a solid testimonial to the integrity and honor of
    those who file PTSD claims. VVA believes that many who legitimately do
    suffer from PTSD have their claims denied because there are no
    immediate documents that the individual veteran can access to prove his
    or her case. (The VA has the resources and the access to secure the
    evidence if their ``duty to assist'' were not constantly being made
    into a mockery by the way they actually do business.)
        This legislation is long overdue, and is much needed. As long as
    reasonable plausibility is established as to the traumatic event, and
    the VA is directed to use proper diagnostic tools to determine that the
    individual in fact has PTSD (which they often do not, due to poor
    training, poor leadership, poor measurement metrics, and cost cutting
    taking precedence over best clinical procedures), VVA supports H.R.
    5448.
        H.R. 5454 would establish a presumption of service connection for
    amyotrophic lateral sclerosis if a veteran develops a 10 percent degree
    of disability or more at any time. Although it is unclear from what
    we've read of this bill, we assume that veteran must have served during
    the Persian Gulf War. This being the case, VVA supports enactment of
    this bill.
        H.R. 5709, The Veterans Disability Fairness Act, would require the
    Secretary of Veterans Affairs to carry out quality assurance activities
    with respect to the administration of disability compensation.
        This bill, while well-intentioned, seems to ask for the obvious: to
    help ensure ``the accuracy and consistency across different offices
    within the Department of the treatment of claims for disability
    compensation, including determinations with respect to disability
    ratings and whether a disability is service-connected.'' Yet anything
    that will help the VA achieve accuracy and consistency in this regard
    is to be commended. Competency based testing of all VBA employees and
    those accredited to represent claimants, full meaningful accountability
    for supervisors and managers, and generally solid leadership from the
    top down would go a long way toward cleaning up the mess that this
    system has become, as well. The lack of proper automation of this
    system has been covered by all concerned so often that the yawning need
    for progress on this front goes without repeating.
        Hence, VVA endorses H.R. 5709.
        H.R. 5985, The Compensation for Combat Veterans Act, would
    ``clarify the service treatable as service engaged in combat with the
    enemy for utilization of non-official evidence for proof of service-
    connection in a combat-related disease or injury.''
        While we had difficulty deciphering just what the above seems to
    mean, we do not have difficulty in understanding that the definition of
    a ``combat veteran'' under this act is a bit broad. While it is true
    that even a well-protected rear area in South Vietnam could be subject
    to mortar and rocket attacks and infiltration by sappers, the construct
    that simply to be in a combat zone means one should be treated ``as
    having engaged in combat with the enemy'' doesn't hold up. It demeans
    those troops who in fact do engage in combat with the enemy.
        A clerk in Long Binh in 1970, while in a putative combat zone,
    lived in effect in a city. To give him, or her, the same status as an
    infantryman is simply wrong. On the other hand, we know many veterans,
    of both Vietnam and the current conflicts, who had military jobs that
    were ostensibly ``non-combat'' such as engineers or truckdrivers who in
    some case had much more direct engagement with the enemy under hostile
    fire than some who had an infantryman's designation. Today the military
    recognizes at least some of these persons with a combat action badge.
    However, that is not the case for those who served in Gulf War I,
    Vietnam, or earlier conflicts.
        The notion that only those with a Combat Infantryman's Badge (CIB)
    have been exposed to combat, or the hazards of a combat theater of
    operations, is far too narrow. The notion is this bill may well be far
    too broad. There needs to be further development work regarding the
    intent of this bill, and whether there is a better way to achieve that
    objective. Further, at least part of what may be the intent of this
    bill may well be covered by H.R. 5448.
        VVA cannot endorse H.R. 5985 in its present form without further
    work, and without better understanding the aim of this proposal, which
    is not immediately ascertainable.
        H.R. 6032 would direct the Secretary of Veterans Affairs to provide
    wartime disability compensation for certain veterans with Parkinson's
    disease.
        There is significant scientific evidence that associates the onset
    of this malady with one's military service in Vietnam veterans in
    particular, due to exposure to Agent Orange, Agent Pink, and the
    potpourri of other poisons in the toxic soup in which we lived and
    fought during the Vietnam War. VVA has no difficulty in supporting
    enactment of this bill.
        On H.R. 6114, The SUNSET (Simplifying and Updating National
    Standards to Encourage Testing of the Human Immunodeficiency Virus) ACT
    of 2008, VVA takes no position.
        H.R. 6122 would direct the Secretary of Veterans Affairs to develop
    and implement a comprehensive policy on the management of pain
    experienced by veterans enrolled for VA healthcare services.
        It seems to us that the Veterans Health Administration already
    takes a pro-active interest in pain; certainly, just about every
    veteran who is examined by a nurse is asked about his/her level of
    pain. Still, while this bill seems a bit redundant with what the
    Department is already doing, VVA supports its enactment, particularly
    with regard to the VA's program of research into acute and chronic pain
    suffered by veterans.
        VVA thanks the Subcommittee for the opportunity to comment on these
    bills, and will be pleased to reply to your questions.

                   Prepared Statement of Lieutenant Commander
                  Jack B. Alderson, USNR (Ret.), Ferndale, CA

        Chairman Hall, Ranking Member Lamborn and Distinguished Members of
    the Committee. My name is Jack B. Alderson, and I live in Ferndale,
    California. I am a retired Lieutenant Commander from the U.S. Navy
    Reserves and am here today to describe my experiences within the
    ``Project SHAD Technical Staff'' (PSTS).
        In 1964 I was a Lieutenant on active duty in the U.S. Navy and
    received orders to the ``Project SHAD Technical Staff'', as Officer in
    Charge of a Division of five U.S. Army Light Tugs (LTs) at Pearl
    Harbor. The mission of the PSTS and the LTs were to test at sea
    Chemical/Biological Weapons. I was there from September 1964 until
    August 1967. The LTs acted as sampling stations and read targets for
    disseminated weapon clouds.
        Each LT was manned by a Navy crew with a U.S. Navy Lieutenant as
    OinC. The LTs were Army vessels with Navy crews operating under a Joint
    Services Command. These were not volunteers, but hand picked personnel
    with ``Final Secret'' clearance ordered to do a job. That job was done,
    and done well. During the 3 years I was with the PSTS LTs, they never
    missed a commitment, and completed all tasks assigned while maintaining
    a fine safety record. This was, at times, a very dangerous job with
    stringent safety precautions and procedures in place.
        I herein stress, that we took every safety precaution within the
    technologies and knowledge available in the 1960's. Sometime later I
    became aware that some of the PSTS personnel were having health
    problems; namely, respiratory and cancer. A knowledgeable medical
    person connected with the tests stated to me that ``some of the
    materials used to decontaminate the LTs after a test are now known to
    be carcinogenic''. Decontamination agents used were Betapropiolactone,
    Formalin, Ethylene Oxide and HTH (Chlorine). Please see attachment.
    Further concern is here for the PSTS staff, as the FDA had not approved
    the inoculations administered to them. Security conditions precluded
    any of this being placed in our official health records. In fact, some
    of our health records are missing.
        Upon return to Pearl Harbor the PSTS, including the Light Tugs took
    part in training and in tests involving simulants. Named tests included
    Fearless Johnny, Big Tom, Folded Arrow and others on and around the
    Hawaiian Islands. Some of these simulants have now been shown to have
    harmful affect on humans when exposed. The decontamination agents and
    procedures are the same as for the live weapons tests.
        I also took three of the LT's on two Bird Cruises. Wherein we had
    on board scientists including ornithologists from the Smithsonian
    Institute. The purpose of the Bird Cruises was to make sure none of the
    indigenous birds of the central Pacific were carrying any residue of
    the tests.
        After I left the PSTS in 1967 they continued to operate for a
    number of years. Some of their operations were off the California
    coast. I know this because I was then assigned to ``Fleet Training
    Group San Diego'' where I wrote the weekly operation order assigning
    operating areas and training assets. In 1968 I received a request for
    operating areas for the USS Herbert J Thomas (DD833) and five Army
    Light Tugs. Since some tugs sailors and I had trained the DD I can
    guess what they were doing.
        My concern is for the personnel of the PSTS, who with full trust in
    their country, did what they were told to do and did it well. Many of
    these persons are dead, and many have health problems that may well
    have started with their participation in SHAD. Importantly, their
    present attending physician would not equate present health problems to
    something that happened many years ago.
        As I stated, I became aware of the problem some years ago when I
    heard from the SHAD veterans that they could not get care at VA clinics
    and were turned away because they could not fully describe what
    occurred to them. At first we were told that no such testing happened.
    The Army said they had concerns but took no action until forced. In
    fact, a letter dated August 23, 2000 from Maj. General J. M. Cosumano,
    Assistant Deputy Chief of the Army, states that everything remains
    classified but only simulants were used, and protective clothing worn .
    . . Untrue.
        During the initial efforts to expose what was happening to SHAD
    veterans I found I had a severe Malignant Melanoma and that brought
    home to me the concerns of other SHAD veterans. I now have other health
    concerns possibly attributable to SHAD operations.
        On September 13, 2001, DoD released three sets of FACT SHEETS. One
    set was for ``Operation Shady Grove'', listing as participating units
    the 5 LTs.
        Upon completing our training and inoculations we were considered
    ready to participate in test operations. We were ordered to standby to
    get underway on 2 January 1965. We were ready, and then told to stand
    down as the President has not signed the operational document.
    President Johnson did sign, and we were underway for Johnston Island on
    21 January 1965 for ``Operation Shady Grove'', the testing of
    Biological Weapons, simulants and trace elements. This operation was
    under control of the Deseret Test Center, Fort Douglas Utah and
    personnel from Dugway Proving Ground.
        The aforementioned ``FACT SHEETS'' are incomplete and contain
    erroneous information such as dates of test and not naming
    decontamination agents as examples.
        ``Operation Shady Grove'' was staged from Johnston Island. Prior to
    commencement, the LTs were scripted for the next 6 days of operation as
    radio silence was imposed. The LTs would pick up the test sampling
    material and animals from the USS Granville S Hall (YAG 40), Granny,
    and proceed to their assigned position on the grid. At twilight the
    monkeys were placed in cages topside, and the LT buttoned up. U.S.
    Marine A 4s would disseminate the agent, simulants and trace elements
    up-wind of the LTs and down wind of the Granny. The weapons cloud would
    then drift down over the grid while samples were being taken. In the
    morning, the exterior decontamination crew would exit the interior and
    decontaminate the exterior, including wrapping up the monkeys for
    transfer to the Granny. Even though the Light Tugs had air pressure and
    filtering systems, they leaked. We know this from the instruments
    inside the tugs. We were not worried as we were inoculated . . . Right?
        After 6 days of operations the LTs would return to Johnston Island
    for a three-day rest and repair. During this break sometimes the tugs
    were decontaminated on the interior. Our decontamination agents are now
    considered carcinogenic.
        Personnel from the Deseret Test Center and Dugway have often stated
    that LT crew should have been in protective clothing during a test and
    we were not. In fact, there was none on the LTs. The exterior
    decontamination crew wore cotton coveralls with rubber bootie and
    gloves, plus a gas mask. Exterior decontamination was done by a crew of
    three by hand using HTH in a soapy solution. These three were the only
    members with gas masks. When they completed decontaminating they
    stripped placing every thing they wore in a metal trashcan, taping it
    shut and through a fitting releasing an aerosol of Ethylene Oxide onto
    the clothing, entering the vessel through an air lock and showering on
    the way. There were no washing machines on the tugs, so the next day
    the exterior crew donned their equipment and did it again. Ethylene
    Oxide ia a known Carcinogen as is HTH.
        Periodically it was necessary to decontaminate the interior of the
    tugs. This was accomplished by using a fogging device with the fog made
    from Betapropiolactone and Formalin, both of which are highly
    carcinogenic. To make sure the fog penetrated everywhere every locker
    every drawer was open the only sealed item was the galley refrigerator.
    After a period of time the tugs were opened up and aired out. However,
    when we went inside the liquid was running down the bulkheads and the
    interior atmosphere caused our eyes to smart and some personnel
    received rashes. Our bunks and clothing were damp from the fog.
        I understand security classifications and the sensitivity of our
    operation. However, these were not volunteers but service personnel
    ordered to do a dangerous job and they did it, and did it well, now
    their Nation needs to take care of them.
        I thank Representative Mike Thompson who has stuck with us for a
    number of years even while members of the administration said there was
    no SHAD. Appreciation also goes to Representative Rehberg for joining
    in this task.
        I thank you Chairman Filner, Ranking Member Buyer, and Members of
    the Committee, and herein respectfully request that H.R. 5954 be moved
    from Committee to the Floor of the House with the recommendation for
    approval.
        If you have any questions I will try to answer them.

                       Prepared Statement of Jeff Faull,
      McEwersille, PA (Disabled Veteran), on behalf of The ALS Association

        Good afternoon Chairman Hall, Congressman Lamborn and Members of
    the Subcommittee. My name is Jeff Faull and I am from a small town in
    northeastern Pennsylvania called McEwensville. I appreciate the
    opportunity to speak with you this morning on behalf of The ALS
    Association and veterans living with ALS across the country. I hope
    that by sharing my experience with you today, you will gain a better
    understanding of how this disease impacts veterans across the country
    and why H.R. 5454 is so urgently needed.
        Before I begin, I would like to thank Congressman Henry Brown and
    Congressman David Price for their leadership in introducing this vital
    legislation. Veterans with ALS across the country truly are grateful
    for their efforts.
        I joined the Navy in 1992 at the age of 24 and served two tours of
    duty as a nuclear electronics technician (Navy Nuke), including over 4
    years aboard the U.S.S. Theodore Roosevelt. During that time I
    participated in Operations Southern Watch, Deliberate Force, Allied
    Force and Noble Anvil. Prior to my assignment aboard the Roosevelt, I
    was stationed at the Knolls Power Laboratory Kesselring Site in West
    Milton, NY located not too far from your district Mr. Chairman.
        I left the Navy in 2000 to spend more time with my wife Tammy and
    our two daughters Tiffany and Breanna. Like many other veterans, I
    never thought that my service in the military would cause health
    problems years after I left the service. I never thought that I would
    have to fight to obtain benefits from the VA and I never thought I
    would be sitting here before you today having been diagnosed with ALS,
    or Lou Gehrig's disease. But for me and thousands of veterans across
    the country, the reality is that, years--and even decades--after
    serving our country, we are being diagnosed with ALS and we are
    fighting for benefits at the same time we are fighting this disease.
        I was diagnosed with ALS just over a year ago in February 2007 at
    age 38, about 20 years younger than the typical person with ALS. At the
    time, I had no idea what ALS was. Amyotrophic lateral sclerosis meant
    nothing to me, as I'm sure it means nothing to thousands of others when
    they are first diagnosed. But I can assure you it's a whole different
    story when your doctor uses phrases such as ``unfortunately, you don't
    have cancer.'' That's when you begin to understand how serious ALS
    really is.
        ALS is a rapidly progressive, invariably fatal, neurological
    disease that attacks the neurons responsible for controlling voluntary
    muscles. To put it simply, this disease will rob me of my ability to
    walk, talk, move and breathe. There is little I can do to slow the
    progression of the disease as there is no effective treatment available
    for ALS, nor is there a cure. The disease is usually fatal in about two
    to 5 years. In fact, of the more than 2,000 veterans who have enrolled
    in the VA ALS registry over the past 4 years, less than 900 are still
    with us today.
        I first noticed the symptoms of ALS as early as 1999 when I
    experienced cramps and twitching in my left hand and arm. As time
    passed, I began to develop weakness then loss of muscle mass, which
    eventually led to my diagnosis last year. Since my diagnosis, the
    weakness and atrophy which began in my left hand has not only worsened
    but spread. Both hands and arms are now weak, walking is becoming more
    difficult and, as you can hear, my speech is beginning to be affected.
        I keep a pair of slip-joint pliers in the kitchen to help open
    things. My wife Tammy who's with me here today normally makes sure that
    things like cereal boxes are opened for me otherwise I have to ask for
    help from my daughters. Although they are more than happy to help their
    ``old man'' this is not how I pictured spending my time with my
    daughters. I can't make the walk to see Breanna play soccer. I don't
    have the arm strength to shoot a basketball with my older daughter
    Tiffany. I will more than likely be in a wheelchair when it comes time
    to teach them to drive. These are the treasures this disease steals
    from thousands of veterans every year. That is, before the disease
    takes our lives.
        Several studies, including studies funded by the Department of
    Defense and the Department of Veterans Affairs have found that military
    veterans of the 1991 Gulf War are approximately twice as likely to
    develop ALS as those not deployed to the Gulf. As a result, the
    Secretary of Veterans Affairs established a presumption of service
    connection for those veterans with ALS who served in the SW Asia
    Theater of Operations from August 2, 1990 to July 31, 1991.
        However, the increased risk of ALS is not confined to veterans of
    the Gulf War, nor is it limited to veterans who served during a time of
    war. Researchers at Harvard University have found that military
    veterans from other eras, ranging from before World War II to after
    Vietnam, also are nearly twice as likely to develop ALS as those who
    have never served in the military. The study did not even consider Gulf
    War veterans. Moreover the study showed that veterans were at greater
    risk of ALS regardless of whether they served during a time of war or
    peace, or whether they served at home or abroad.
        The Institute of Medicine reviewed these and other studies and
    reported in November 2006 that existing evidence supports the increased
    risk of ALS for veterans. In fact, I understand that recent research,
    which has not yet been published, suggests that ALS is occurring at
    greater rates in those who are serving in the current conflict in Iraq.
    And what's alarming about this information, and the evidence from prior
    research is that we are seeing ALS in veterans at an age when we
    generally do not see the disease. I was 38 when I was diagnosed. Most
    people are diagnosed in their fifties, sixties and 70s. What will we
    see 10, 15, 20 years in the future as the men and women serving today
    leave the military?
        It is clear that regardless of when or where someone served in the
    military, they are at a greater risk of dying from the disease than if
    they had not served in the military.
        The Department of Defense and the VA also recognize that there is a
    relationship between military service and the development of ALS. In
    addition to Gulf War veterans, veterans who experience symptom onset or
    are diagnosed with ALS while on active duty or within 1 year of
    discharge are presumed service connected. DoD, VA and Congress also
    have invested funding for ALS research, including establishing the
    Veterans ALS Registry at the VA and creating the peer reviewed ALS
    Research Program at DoD, which is seeking treatments for veterans with
    ALS.
        However, despite the evidence showing that all U.S. military
    veterans are at a greater risk of ALS, the VA has not created a
    presumption of service connection for all veterans with ALS. Thousands
    of veterans continue to be left behind and hundreds of thousands
    serving in the military today, including in Iraq and Afghanistan,
    continue to be at a greater risk of dying from the disease.
        The VA will respond that any veteran with ALS can be granted
    service connection on the basis of specific evidence supporting their
    case. As someone who has been denied service connection, and knows
    countless others who have as well, I can tell you that this response
    demonstrates a lack of understanding of the disease.
        The reality is that the majority of veterans with ALS, who do not
    fall under the current limited presumptions, are forced to fight for
    their benefits. And we are usually denied. I have been attempting to
    establish service connection for over a year now and have submitted
    reams of scientific and medical evidence, including letters supporting
    my claim from my neurologist. Yet that evidence has fallen on deaf
    ears.
        Part of the problem we face is the nature of the disease itself.
    ALS is an insidious disease. First the symptoms, such as the ones I
    experienced while on active duty, are so benign that they go unnoticed
    or unreported. How many of us in this room have experienced muscle
    cramps and twitching and thought nothing of it? These are symptoms of
    ALS, yet they are not documented in our service medical records simply
    because we did not think they were a big deal at the time--after all,
    we were in the military. How many of us on active duty actually thought
    that we would succumb to muscle twitching?
        In addition, it can be years from discharge until the onset of
    symptoms or between onset and diagnosis--well after the 1 year
    presumptive period has ended. And there is no simple way to diagnose
    ALS, no single test you can take that says you have ALS. Rather it is a
    diagnosis of exclusion, made by ruling out every other possible
    diagnosis.
        The bottom line is that if you were not diagnosed while on active
    duty and did not serve in the Gulf, the VA likely will not consider ALS
    to be service connected. This, despite the studies and the fact that
    the VA and DoD both recognize ALS to a high priority for research.
        In addition to the studies that I have referenced and which are
    included in the ALS Association report, ALS in the Military; the
    Unexpected Consequences of Military Service, there are multiple peer
    reviewed studies linking ALS to many of the things our military
    personnel are exposed to on a regular basis. These include ionizing and
    non-ionizing radiation, fuels, solvents, lead, vapors and vaccinations.
    In fact, recent peer reviewed studies and World Health Organization
    guidelines link some of the vaccines given to our military personnel as
    a possible cause of ALS.
        My question, as a veteran with ALS trying to establish service
    connection is what additional proof must I provide? How many more
    studies are needed? How many veterans have to develop ALS and die from
    it before the VA takes action?
        I can only hope that this quick glance into my life with ALS and
    attempts with service connection grant you the understanding to see the
    importance of establishing a presumption of service connection for all
    veterans with ALS, which is exactly what H.R. 5454 would do. We have to
    fight for our lives. We should not also have to fight for the benefits
    that the evidence shows we deserve.
        Abraham Lincoln's statement which was later adopted by the VA as
    their motto states, ``to care for him who shall have borne the battle
    and for his widow, and his orphan''. I and the other veterans with this
    horrible disease appreciate your time and effort to ensure that
    statement is more than words. I urge you to support H.R. 5454 and help
    ensure that no veteran with ALS is ever left behind. Thank you again
    for your time and the opportunity to speak with you.

                       Prepared Statement of David Woods,
                 Director, Veterans Affairs of Scott County, IA

        Mr. Chairman and Members of the Committee, thank you for allowing
    me to be here today to discuss Congressman Braley's bill, The
    Compensation for Combat Veterans Act. I am the Director of Veterans
    Affairs of Scott County in Iowa. I am also a Vietnam combat Veteran. I
    have been awarded the C.I.B., the Purple Heart and the Silver Star from
    being wounded June 12th 1970 in Nam. So I have a feeling for just what
    our Veterans are going through.
        My job as a Veterans Service Officer for Scott County is to listen
    to these Veterans, get them the medical help and compensation which is
    due them. I also help them through the Veterans Administration tangle
    of paperwork and to make sure that they understand what they are
    entitled to. Having witnessed my combat experiences, I understand and
    am able to talk and relate to what these Veterans are going through.
    They will tell me things that they have told nobody else, not even
    their wives or family.
        I have had Veterans come into my office asking him where, when, and
    what unit were you with, who was wounded or killed near you. He just
    stared at me and replied that he had no idea what the date was or maybe
    they were working with a different unit than his own, so he had no idea
    who the guy was that got wounded, but the Veteran was there.
        Now, how about our Vietnam Veterans who have been trying to forget
    his time in Vietnam, the cases of PTSD are rising since the start of
    the Iraq, Afghanistan Wars. After 40 years, have him try to remember
    when he was attacked or even the name of a buddy who was injured. I
    know that when most of us were in combat we did not have calendars with
    us and as to where we might have been, we just followed our leader's
    orders. Asking these questions sometimes just brings back bad memories,
    memories which we were trying to forget.
        For our Iraq, Afghanistan Veterans, there are times when that MP or
    engineer or even a cook might be pulled from his job and be sent on
    convoy duty. Many times when that change happens, it is not documented
    for the files. Then when he is sent on that job, he might not be
    working with his own unit or his combat buddies. If they receive
    incoming rounds it is not documented; it's just an everyday occurrence.
        I have had National Guard Veterans whom had been activated, come
    into my office for compensation claims, which we filed. The Veterans
    Administration has turned down these claims because part of the units
    were still on duty and all of the units' records were still over with
    the rest of the unit. Then we had to track down a buddy that might have
    witnessed what had happened to the Veteran. Now with the Guard you have
    to remember that they might not see that certain buddy until drill
    weekend, if they drill together in the same unit. Also their days also
    ran together and they had no idea when they were fired on. When they
    were in a certain village or city they at least knew that much.
        I have had an Iraqi Veteran with T.B.I. (Traumatic Brain Injury)
    file for compensation but because he had no C.B.I or Purple Heart or
    other combat medal, he was turned down by the VA for his compensation.
    His DD 214 showed that he was in Iraq listing the date and unit, but
    nothing else. When we filed the compensation claim, that Veteran was
    tested and treated at the Iowa City VA Medical Center. He was found to
    have T.B.I. and he was awarded his compensation claim.
        If you were to ask a combat medic just what his job was, you would
    be told that he was to keep that injured soldier alive and to let the
    people in the background do the paperwork. If you were to look at my
    medical report, it says that I was injured in the left arm and the
    neck. Neither happened to me when I was hit. That medic did not carry a
    file for each of us to report every little wound or knock to us. It was
    not possible and it's still not possible to keep track of these
    records.
        Case in point, I had a W.W. II Veteran come into my office wanting
    to get his Purple Heart which he had never gotten. His records were
    burned up in St. Louis and he really wanted it for his family. He was
    injured in Germany and sent to France for his medical treatment. While
    in the hospital in France he was told that his Purple Heart would be
    given to him when he got back to his combat unit. On returning to that
    unit he was informed that he should have received it while in France.
    He just wanted to get home so he forgot about it until his kids asked
    about his awards. While talking to him I found out what unit he was
    with and when and where he was injured. I sent a message to the Unit
    Records section in St. Louis; when we got the response with his name on
    the records, it said that he was in the hospital for illness not an
    injury. Since the other tank members were all deceased, he was dead in
    the water for his Purple Heart. Just another show of great military
    records keeping for the Veteran.
        I had a Vietnam Veteran come into my office to apply for
    Compensation for Agent Orange Type II Diabetes. This Veteran was a Navy
    deep water Veteran and when he applied for his compensation, the VA
    turned him down stating the ``Hass vs. Nickelsen'' case that he was
    never in Vietnam. I asked the Veteran if he had contact with any of his
    shipmates and the very next day he had e-mail addresses for two of his
    shipmates. I contacted one of the two, and it turned out that he was
    the third officer on the ship. His letter back to me was a statement
    telling that it was common knowledge that the replacements would fly
    into Vietnam, truck 2 days down to the tip of Nam, and then be boated
    out to the ship. Then to add insult to injury to the VA and the records
    keeping, he mentioned that every two or 3 months they would all land on
    an island beach off of Vietnam for volleyball and R & R. We are still
    waiting to hear from the VA on that case.
        These are just a fraction of the Compensation Claims which we are
    fighting with the VA. These last wars are not like W. W. I and not like
    W. W. II where you knew whom the enemy was or where the frontlines
    were. Now we have no lines or enemies in a certain uniform. There are
    not many ``safe areas'' when the Veterans of today can actually relax.
    It doesn't take much incoming to put stress and pressure on our
    Veterans and that is what we are finding out today.
        Thank you for letting me speak to you today.

                    Prepared Statement of Bradley G. Mayes,
         Director, Compensation and Pension Service, Veterans Benefits
              Administration, U.S. Department of Veterans Affairs

        Mr. Chairman and Members of the Committee, I am pleased to be here
    today to provide the Department of Veterans Affairs' (VA) views on
    pending benefits legislation. Accompanying me is Richard J. Hipolit,
    Assistant General Counsel. VA is still reviewing H.R. 5448 and will
    provide views on that bill in a subsequent views letter.
                                   H.R. 1197
        H.R. 1197, the ``Prisoner of War Benefits Act of 2007,'' would: (1)
    repeal the current minimum 30-day internment period required for
    veterans who are former prisoners of war (POWs) to be entitled to
    presumptive service connection for the disabilities listed in 38 U.S.C.
    Sec. 1112(b)(3); (2) add type-2 diabetes and osteoporosis to the list
    of disabilities presumed service connected for former POWs; and (3)
    authorize VA to administratively determine, and establish procedures
    for such determinations, whether to add or remove diseases from the
    list of POW presumptions. The bill would require VA, in making such
    determinations, to take into account the recommendations received from
    the Advisory Committee on Former Prisoners of War and, whenever that
    Committee recommends that a presumption of service connection be
    established for a disease, to make the determination not later than 60
    days after receipt of the recommendation. VA would have 60 days after
    that to either propose regulations to implement a positive
    determination or publish a notice of a negative determination. Final
    regulations would be required not later than 90 days after any proposed
    regulations are issued.
        VA does not support this bill for the following reasons:
        The diseases already listed in section 1112 have been medically and
    scientifically associated with the harsh physical and psychological
    conditions associated with POW internment. It is unreasonable to assume
    that the extreme deprivation associated with the diseases listed in
    section 1112(b)(3) occurred during internment periods of less than 30
    days, particularly those diseases associated with nutritional
    deprivation. These diseases include avitaminosis, chronic dysentery,
    helminthiasis, malnutrition, pellagra, cirrhosis of the liver,
    peripheral neuropathy, irritable bowel syndrome, peptic ulcer disease,
    atherosclerotic heart disease or hypertensive vascular disease and
    their complications, and stroke and its complications.
        VA is not aware of any credible scientific or medical literature or
    study that has associated type-2 diabetes mellitus or osteoporosis with
    POW internment.
        The timeline S. 1197 would mandate for making determinations and
    publishing regulations is untenable. Determination of whether any
    particular malady should be added to the list of diseases warranting
    presumptive service connection must reasonably involve a lengthy
    process of scientific study. Sixty days is insufficient time for the
    Secretary to be able to evaluate a recommendation to create a new
    presumption.
        We estimate the benefit costs of this bill to be $61.1 million
    during fiscal year (FY) 2009, $440.1 million for 5 years, and $798.2
    million over 10 years. The bill would minimally affect workload, so
    full-time employee (FTE) costs would be insignificant.

                                   H.R. 3008

        H.R. 3008, the ``Rural Veterans Services Outreach and Training
    Act,'' is intended to improve outreach and assistance to veterans and
    their dependents who may be eligible to receive VA benefits and are
    residing in rural counties, through the training of rural county
    veteran service officers. To this end, H.R. 3008 would establish a
    competitive grant program to provide financial assistance to state
    departments of veterans affairs.
        Although VA supports the intent of H.R. 3008, we oppose the bill
    because it would duplicate ongoing efforts by the Veterans Health
    Administration's Office of Rural Health (ORH) to address the health
    care needs of veterans in rural areas, as well as duplicate other
    outreach activities already conducted by VA for veterans in rural
    areas.
        The ORH has been initiating innovative programs to improve care and
    services for veterans who reside in geographically isolated areas,
    including the following:

          Rural Mobile Healthcare Clinic: The ORH recently
    disseminated a nationwide Rural Mobile Healthcare (RMHC) Clinic Pilot
    Request for Proposals, to extend access to primary care and mental
    health services in rural areas where it is not feasible to establish a
    fixed access point. Although the primary focus of RMHC is to enhance
    the delivery of care to rural veterans, secondarily it can address
    outreach and collaborate with community partners. The ORH expects to
    complete the selection of the pilot sites by the end of summer 2008.
          Veterans Integrated Service Networks Rural Consultants:
    The use of Veterans Integrated Service Networks (VISN) Rural
    Consultants was mandated by section 212 of Public Law 109-461. The
    consultants will enhance service delivery to veterans residing in rural
    areas, will lead activities in building an ORH Community of Practice to
    facilitate information exchange and learning within and across VISNs,
    and support a stronger link between ORH and the VISNs. The ORH recently
    disseminated a nationwide Request for Proposals and intends to fund
    eight consultants. We expect to complete selection of consultants by
    the end of 2008.

        VA believes the results of the RMHC Pilot Initiative and the VISN
    Rural Consultants program will enhance healthcare services for veterans
    and guide the future direction of other potential initiatives, such as
    those contemplated by H.R. 3008.
        In addition to the abovementioned rural healthcare initiatives, the
    following are examples of other outreach services occurring in rural
    areas:

          Vet Centers provide readjustment counseling and outreach
    services to all veterans who served in a combat zone. Certain services
    are also available for their family members. The goal of the Vet Center
    program is to provide a broad range of counseling, outreach, and
    referral services to eligible veterans to help them successfully
    readjust to civilian life. The Vet Centers are community-based and
    staffed by small multi-disciplinary teams of dedicated providers, many
    of whom are combat-veterans themselves. The Vet Center staff routinely
    visits rural communities to provide outreach and direct readjustment
    services. The Vet Center program has initiated its own community
    outreach vehicle project and is in the process of selecting sites for
    50 outreach vehicles. The measures outlined in H.R. 3008 would be
    duplicative of their efforts.
          VA is conducting a substantial amount of outreach,
    counseling, and education for returning Reserve and National Guard
    members and their families. Effective May 1, 2008, at the Secretary's
    request, an estimated 570,000 Operation Enduring Freedom and Operation
    Iraqi Freedom (OEF/OIF) veterans are being contacted and given
    information on VA medical services and other benefits available to
    them.
          VA currently engages in a range of activities to educate
    VA staff and other agencies and organizations involved in helping
    veterans and dependents, such as community service providers, school
    officials, lenders, service organizations.
          The Healthcare for Homeless Veterans Outreach program.
          The Tribal Veteran Representative programs.
          Seamless transition programs for OEF/OIF veterans.
          Educational patient support groups

        VA's outreach efforts also include activities that assist veterans
    generally, such as attending benefit fairs and exhibits at conferences,
    conventions, veteran service organization meetings, Federal boards, and
    townhalls, and participating in a range of Department of Defense-
    related activities such as Transition Assistance Program (TAP)
    briefings and National Guard and Reserve component conferences.
        H.R. 3008 has insufficient detail to fully develop a cost estimate.
    The grant costs associated with this bill could range anywhere from no
    cost to $50 million annually. VA would incur additional costs to
    administer the program, but we are unable to determine FTE costs at
    this time.

                                   H.R. 3795

        H.R. 3795, the ``You Were There, You Get Care Act of 2007,'' would
    add to the list in current law of diseases presumed to be service
    connected for a radiation-exposed veteran any other disease ``covered''
    under 38 CFR Sec. 3.309 or 3.311, as well as any other disease found by
    VA to result from exposure to depleted uranium or the by-products of
    the burn-off that occurs when a depleted uranium munition penetrates a
    target. H.R. 3795 would also require that a veteran who served in the
    Persian Gulf War or any subsequent conflict in which depleted uranium
    munitions were used, if that service was in a theater of operations or
    involved the clean-up or servicing of vehicles or equipment that had
    been in such a theater of operations, be considered a ``radiation-
    exposed veteran'' for purposes of the presumptions of service
    connection for such veterans. The bill would require the Secretary to
    provide for an independent in-depth medical study to be conducted by
    civilian medical entities to determine other diseases that may result
    from exposure to depleted uranium. Upon receiving the report of the
    study, the Secretary would have to transmit a copy of the report to the
    Congressional veterans' affairs committees.
        VA does not support this bill because it would create an overly
    broad presumption. Although the statutory provision the bill would
    amend provides a presumption for diseases associated with exposure to
    ionizing radiation, section 3.309 covers many conditions not associated
    with radiation exposure, such as chronic diseases, tropical diseases,
    diseases specific to former POWs, and diseases associated with exposure
    to certain herbicide agents. H.R. 3795 would extend the presumption of
    service connection for radiation-exposed veterans to all of these
    unrelated diseases.
        The scope of H.R. 3795 is also extremely broad in covering veterans
    who served in the theater of operations in a conflict in which depleted
    uranium munitions were used. Depleted uranium munitions are used
    primarily as anti-tank rounds. The bursting radius of those rounds is
    much smaller than that encountered in above-ground nuclear tests.
    Furthermore, the provision could be read to include ``in the theater of
    operations'' servicemembers who served at sea or in airborne operations
    whose service occurred far from where these weapons were used. Exposure
    to hazards from depleted uranium would be very unlikely, if not
    impossible for such servicemembers.
        We are developing a benefit-cost estimate for this bill and will
    submit it for the record. No additional FTE costs would be associated
    with this bill because a minimal impact on workload would be expected.
    We estimate that discretionary costs related to the study, based on
    previous contracts, would be less than $2 million.

                                   H.R. 4274

        H.R. 4274, the ``Gold Star Parents Annuity Act of 2007,'' would
    provide a monthly benefit of $125 to parents of servicemembers who lost
    their lives while on active duty in certain military operations
    described by 10 U.S.C. Sec. 1126(a). If more than one parent is
    eligible for the benefit, it would be divided equally among the
    eligible parents.
        VA honors the sacrifice of the servicemembers who have lost their
    lives in the service of their country. VA also recognizes and honors
    the supreme sacrifice of Gold Star parents, who have lost a son or a
    daughter serving in the Armed Forces. However, VA does not support this
    bill because VA already provides a monthly benefit to certain
    qualifying parents.
        Parents' dependency and indemnity compensation (DIC) is a monthly
    benefit that is currently paid to eligible surviving parents of a
    veteran who died while on active duty, or after service as a result of
    service-connected disability. Parents' DIC is a need-based income-
    support benefit.
        H.R. 4274 would authorize a small benefit, which would be divided
    among eligible parents if there is more than one. The administrative
    burden of paying this benefit would be great relative to its size.
    Additionally, the bill would provide disparate treatment. Although it
    may be appropriate for the Congress to distinguish between combat-
    related deaths and other service-related deaths, the requirement that
    the servicemember have died while engaged in combat operations and on
    active duty fails to acknowledge that some post-service deaths,
    particularly in the early years following separation, can be tied
    directly to battle wounds and thus creates at least the appearance of
    disparate treatment.
        Costs for this bill cannot be estimated at this time.

                                   H.R. 5155

        H.R. 5155, the ``Combat Veterans Debt Elimination Act of 2008,''
    would prohibit VA from collecting all or part of a debt owed to the
    United States under any program under the laws administered by VA
    (other than a housing or small business program under chapter 37 of
    title 38, United States Code) by a veteran who dies as a result of a
    service-connected disability incurred or aggravated while serving in a
    theater of combat operations in a war after the Persian Gulf War or in
    combat against a hostile force during a period of hostilities after
    September 11, 2001, if the Secretary determines that termination of
    collection is in the best interest of the United States. The amendments
    made by the bill would be effective on the date of enactment and would
    apply ``with respect to collections of indebtedness of veterans who die
    on or after September 11, 2001.''
        VA supports the intent behind this bill, but does have a concern
    with the effective-date provision. That provision is unclear as to
    whether the prohibition on debt collection would apply retroactively to
    a debt already collected before the date of enactment or apply only
    prospectively. We recommend that the bill be amended to require VA to
    refund any amount of a debt of a covered veteran collected after
    September 11, 2001, but before the date of enactment.
        We estimate that enactment of this bill, if amended as recommended,
    would result in additional benefit costs of $5,000 for FY 2009 and a
    10-year cost of $50,000.

                                   H.R. 5454

        H.R. 5454, would establish a presumption of service connection for
    amyotrophic lateral sclerosis (ALS), a rare disease of unknown cause,
    for any veteran who develops the disease to a compensable level at any
    time after separation from service.
        VA does not support this bill. Current evidence does not justify
    the establishment of a presumption for ALS. There is insufficient
    credible scientific evidence that ALS is caused by service or more
    likely to develop in veterans as opposed to the general population.
    Although the Institute of Medicine (IOM) found limited suggestive
    evidence of an association between the development of ALS and military
    service, the IOM clearly indicated that the disease's cause is unknown.
    A review of the literature cited seems to suggest that ALS is
    associated with vigorous people, as would be found in military service,
    but is not unique to the military.
        We estimate benefit costs of this bill to be $23.5 million during
    FY 2009, $214.2 million over 5 years, and $505.8 million over 10 years.
    This bill would minimally affect workload, so FTE costs would be
    insignificant.

                                   H.R. 5709

        H.R. 5709, the ``Veterans Disability Fairness Act,'' would require
    the Secretary to carry out quality assurance activities with respect to
    the administration of disability compensation to ensure accuracy and
    consistency across different VA offices with respect to whether a
    disability is service connected and disability ratings. The Secretary
    would be required to retain, monitor, and store data for each claim for
    disability compensation, to include: (1) the state the claimant resided
    in when the claim was submitted; (2) the Secretary's decision with
    respect to the claim; (3) the regional office and individual employee
    responsible for evaluating the claim; (4) the results of adjudication;
    and (5) such other data as the Secretary determines is appropriate for
    monitoring the accuracy and consistency of decisions.
        H.R. 5709 would further require VA to conduct reviews and audits,
    at least annually, to identify and correct any adjudication
    inaccuracies or inconsistencies. The reviews and audits would have to
    include a sample large enough to draw statistically valid conclusions.
    Additionally, the Secretary would have to consider factors relating to
    consistency and accuracy when evaluating adjudication employees. The
    bill would require the Secretary to report to Congress, within 60 days
    of enactment, on the implementation of this legislation and to include
    information on consistency in the annual report required by 38 U.S.C.
    Sec. 7734(2).
        VA does not support H.R. 5709. VA already has measures in place,
    and is implementing additional measures, that address most of the
    subjects covered in H.R. 5709. VA has a robust quality assurance
    program. Quality reviews are conducted on a statistically valid sample
    of adjudicated claims. VA will begin routinely monitoring the most
    frequently rated diagnostic codes in FY 2008 to assess consistency of
    service-connection determinations and degree of disability assigned for
    various disabilities across regional offices. VA conducts regular site
    visits at VA regional offices to assess operations for consistency and
    accuracy. In addition, a random sample of cases adjudicated by
    employees responsible for adjudicating claims is reviewed for quality
    at the regional offices. The results of this review represent one
    element of employee performance.
        Training is an integral part of VA's quality assurance program. The
    Center for Naval Analyses reviewed VA's training efforts for the
    Veterans' Disability Benefits Commission and was highly complimentary
    of VA's training efforts in testimony before the Commission. Also, in a
    recent assessment of the Department of Defense (DoD) Disability
    Evaluation System, the Government Accountability Office referred to the
    VA Compensation and Pension quality review program as a favorable model
    for adoption.
        Because the bill would not affect benefit entitlement, no mandatory
    costs would be associated with it. There would be no additional FTE
    costs because the bill would not affect workload, and VA already
    maintains a staff to conduct quality and consistency reviews.

                                   H.R. 5954

        H.R. 5954 would: (1) establish a presumption of service connection
    for any diagnosed disease determined by the Secretary to have an
    increased incidence in veterans exposed to a biological, chemical, or
    other toxic agent known or presumed to be associated with service
    during which the veteran was directly or indirectly subjected to a
    chemical or biological warfare test or project under Project 112; (2)
    require the Secretary to determine the presumptive period during which
    such disease must manifest itself to warrant a presumption of service
    connection; (3) establish a presumption of such exposure if the veteran
    was subjected to a Project 112 test; and (4) require the Secretary to
    notify, under regulations prescribed not later than 180 days after
    enactment, all veterans who were potentially exposed to any biological
    or chemical agent, simulant, tracer, or decontaminant during Project
    112 of the potential exposure.
        Further, this bill would require DoD, in consultation with VA, to
    submit to Congress, within 1 year after enactment, a report that would:
    (1) document the costs, benefits, and challenges associated with
    continuing the search for additional Project 112 participants; (2)
    provide a full accounting of all information known concerning Project
    112 participants; and (3) address other concerns regarding Project 112
    held by the VA, veterans, or veterans service organizations.
        Project 112 was a comprehensive program initiated in 1962 by DoD to
    protect and defend against potential chemical and biological warfare
    threats. Project SHAD (an acronym for Shipboard Hazard and Defense), a
    component of Project 112, encompassed a series of tests by DoD to
    determine the vulnerability of U.S. warships to attacks with chemical
    and biological warfare agents, and the potential risk to American
    forces posed by these agents. Project 112 also involved similar tests
    conducted on land rather than aboard ships.
        VA opposes this bill. VA has already contracted for a significant
    long-term study concerning the health effects on SHAD participants and
    received the report from the IOM. The Secretary has authority to
    contract for an additional study if it is deemed necessary. We believe
    that enactment of this bill is unwarranted at this time due to the lack
    of credible scientific and medical evidence that adequately
    demonstrates any statistically significant correlation between
    participation in SHAD tests and the subsequent development of any
    disease.
        DoD continues to release declassified reports about sea--and land-
    based tests of chemical and biological materials associated with
    Project 112. VA is working with DoD to obtain information regarding the
    tests, including who participated, duration, and agents used. DoD
    estimates that about 6,000 veterans may have been involved in Project
    112/SHAD. To date, DoD has provided VA with the names of approximately
    5,000 veterans who participated in the tests. In May 2002, VA began to
    contact veterans who participated in Project SHAD about medical care
    and benefits to which they may be entitled.
        In October 2002, VA contracted with the IOM to conduct a 3-year,
    $3-million study of potential long-term health effects of tests
    conducted aboard Navy ships in the sixties. IOM's report, ``Long-Term
    Health Effects of Participation in Project SHAD,'' was published in May
    2007 and found no clear evidence that specific long-term health effects
    are associated with participation in Project SHAD.
        We are in the process of estimating the costs that would be
    associated with enactment of this bill, and we will provide them for
    the record.

                                   H.R. 5985

        H.R. 5985, the ``Compensation for Combat Veterans Act,'' would
    require VA to treat certain veterans as having engaged in combat with
    the enemy for purposes of 38 U.S.C. Sec. 154(b), thus permitting the
    use of lay or other evidence for proof of service incurrence of a
    combat-related disease or injury. The veterans who would qualify for
    this treatment are veterans who, during active service with a U.S.
    military, naval, or air organization during a period of war, campaign,
    or expedition, served in a combat zone for purposes of section 112 of
    the Internal Revenue Code 1986, or a predecessor provision of law. In
    essence, this bill would equate service in a combat zone with engaging
    in combat with the enemy. VA does not support this bill.
        Section 112(c)(2) of the Internal Revenue Code 1986 defines
    ``combat zone'' as any area that the President by executive order
    designates as an area in which U.S. Armed Forces are engaging or have
    engaged in combat. Section 112 governs the computation of gross income
    for tax reporting purposes based upon service and applies to all
    veterans who serve in a combat zone regardless of actual involvement in
    combat. The executive order designates which geographical areas are
    combat zones and the date of commencement of combat activities.
        Section 1154(b) of title 38, United States Code, relaxes the
    evidentiary requirements a combat veteran must meet to prove service
    incurrence or aggravation. The language of section 1154(b) makes it
    clear that its purpose is to liberalize the method of proof for claims
    based on injuries incurred or aggravated while engaged in combat with
    the enemy. This provision recognizes the unique circumstances of
    combat, which are not favorable for documentation of injury or illness
    because treatment for such injury or illness may be administered in the
    field under exigent conditions that do not permit concurrent
    documentation. Supporting evidence is often difficult to obtain when a
    veteran later files a claim for disability compensation for a combat-
    related disability. This bill contemplates that all veterans in a
    combat zone are faced with the same difficulty in documenting treatment
    for injury or illness. However, the same difficulty does not exist for
    servicemembers who, although serving in a combat zone, have access to a
    medical facility for treatment and whose treatment would be documented
    in service treatment records. The purpose of section 1154(b) was to
    recognize the unique circumstance of actual combat.
        We cannot estimate benefit costs that would result from enactment
    of this bill because there are no data available upon which to estimate
    the number of claims for service connection filed by veterans for
    disabilities incurred in a combat zone.

                                   H.R. 6032

        H.R. 6032 would establish a presumption of service connection for
    Parkinson's disease for any veteran who served in the Republic of
    Vietnam during a certain period and develops the disease to a
    compensable level at any time after separation from service.
        VA does not support this bill. The Agent Orange Act 1991, codified
    at 38 U.S.C. Sec. 1116, requires that, when the Secretary, on the basis
    of sound medical and scientific evidence, determines that a positive
    association exists between herbicide exposure and a disease, the
    Secretary will issue regulations providing a presumption of service
    connection for such disease. The Agent Orange Act further directs that
    the Secretary take into account reports from the National Academy of
    Sciences.
        The IOM of the National Academy of Sciences has consistently
    determined that there is insufficient evidence to associate Parkinson's
    disease with herbicide exposure. The IOM continued this determination
    in its most recent report, ``Veterans and Agent Orange, Update 2006.''
    VA believes that it should recognize diseases as presumptively
    associated with service only if such association is adequately
    established by credible medical and scientific evidence. Such evidence
    has consistently failed to demonstrate an association between
    Parkinson's disease and herbicide exposure.
        We are in the process of estimating the costs that would be
    associated with enactment of this bill and will provide them for the
    record.
        This concludes my statement, Mr. Chairman. I would be happy to
    entertain any questions you or the other Members of the Subcommittee
    may have.

                    Statement of Hon. Michael L. Dominguez,
                Principal Deputy Under Secretary of Defense for
              Personnel and Readiness, U.S. Department of Defense

        Mr. Chairman and Members of this distinguished Committee, thank you
    for the opportunity to provide views on draft legislation. Our comments
    on several of the bills are below.
        H.R. 3795, the bill provides that veterans of service in the 1991
    Persian Gulf War and subsequent conflicts shall be considered to be
    radiation-exposed veterans for purposes of the service connection of
    certain diseases and disabilities.
        The Department of Defense (DoD) opposes this legislation. This bill
    is very broad and assumes any participation in the 1990-1991 Persian
    Gulf War with subsequent development of diseases, as specified in
    sections 3.309 and 3.311 of Title 38 of the Code of Federal Regulations
    (cancers and other diseases) is based on radiation exposure. It
    eliminates any requirement for evidence of radiation exposure. More to
    the point, the premise that depleted uranium causes a radiation hazard
    that is sufficient to cause adverse health effects in humans is
    unsupportable. Uranium is a very common naturally occurring heavy
    metal, and depleted uranium is 40 percent less radioactive than natural
    uranium. There is no evidence that the extremely low radiation levels
    emitted by depleted uranium can cause illnesses in humans. There is no
    evidence that natural or depleted uranium exposure causes cancer in
    humans.
        H.R. 5454, the bill establishes a presumption of service connection
    of amyotrophic lateral sclerosis (ALS) for purposes of the laws
    administered by the Secretary of Veterans Affairs.
        DoD opposes this legislation. The scientific evidence does not
    support a presumption of service connection of ALS. Although there are
    a couple of reports that show a possible association between ALS and
    military service, there is currently insufficient evidence to conclude
    that ALS is caused by military service. In the general population,
    approximately 10 percent of cases are genetic and the causes of the
    other 90 percent of cases are unknown. Similarly, the causes of 90
    percent of ALS cases in military veterans are unknown. Several research
    projects are underway that will determine whether military veterans are
    at increased risk for developing ALS, compared with individuals who did
    not serve in the military.
        H.R. 5954, the bill provides veterans presumptions of service-
    connection for purposes of benefits under laws administered by
    Secretary of Veterans Affairs for diseases associated with service in
    the Armed Forces and exposure to biological chemical or other toxic
    agents as part of Project 112.
        DoD opposes this legislation. The scientific evidence does not
    support a presumption of service connection for any diseases associated
    with exposure to biological, chemical, or other toxic agents that
    resulted from Project 112 (also frequently called Shipboard Hazard and
    Detection--SHAD, although SHAD was only a component of Project 112).
    Project 112/SHAD was a series of tests which took place in 1962-73. The
    Department of Veterans Affairs requested civilian medical experts in
    the Institute of Medicine (IOM) to perform a comprehensive study of the
    possible long-term health effects of participation in Project 112. The
    IOM study was published in 2007 and concluded that there was no clear
    evidence of specific health effects that were associated with
    participation in Project SHAD.
        In addition, having conducted an exhaustive search for information
    on Project 112/SHAD, DoD does not agree that additional archives
    searching would result in a more complete documentation. However, DoD
    will investigate any new information that may be presented and share
    that information with the Department of Veterans Affairs and the
    public.
        H.R. 5985, the bill clarifies the service treatable as service
    engaged in combat with the enemy for utilization of non-official
    evidence for proof of service-connection in a combat-related disease or
    injury.
        DoD opposes this legislation. This provision equates service in a
    combat zone with engaging in combat with the enemy for the purposes of
    establishing service connection for combat-related diseases or
    injuries. While supporting evidence is often difficult to obtain for
    disability compensation for a combat-related disability, this bill
    provides that all veterans in a combat zone are faced with the same
    difficulty in documenting treatment for injury or illness. However, the
    same difficulty does not exist for servicemembers who, although serving
    in a combat zone, have access to a medical facility for treatment and
    whose treatment would be documented in service treatment records.
        H.R. 6032, the bill directs the VA Secretary to provide wartime
    disability compensation for certain veterans with Parkinson's disease.
        DoD opposes this legislation. This legislation would provide a
    presumption of service connection for Parkinson's disease for veterans
    of the Vietnam War. From 1994 to 2006, the IOM has published seven
    exhaustive reports on the possible health effects of Agent Orange and
    other herbicides used during the Vietnam War, and another report will
    be published during the next year. The IOM has consistently concluded
    that there is insufficient evidence for a link between exposure and
    Parkinson's disease. Therefore, scientific evidence is lacking to
    support a presumption of service connection.

                       Statement of Hon. Bruce L. Braley,
              a Representative in Congress from the State of Iowa

        Thank you, Chairman Hall, Ranking Member Lamborn, and Members of
    the Subcommittee, for considering H.R. 5985, the Compensation for
    Combat Veterans Act, at your hearing today. It is an honor to testify
    before you in support of this legislation.
        I introduced the Compensation for Combat Veterans Act in May in
    order to address a problem faced by too many of our veterans. Today,
    combat veterans are required to provide official evidence that they
    were wounded in a specific combat incident in order to demonstrate that
    their injuries are service-connected. I believe that Congress should
    overturn this requirement, and that service in a combat zone should be
    sufficient evidence to demonstrate that a veteran received their
    injuries in combat.
        The Compensation for Combat Veterans Act would clarify that
    evidence in a veteran's record of assignment in a combat zone is
    sufficient for a veteran to prove their combat service when other
    military documents are unavailable. This bill would remove the
    documentation barriers that in some cases are preventing combat
    veterans from receiving compensation for their disabilities, or which
    cause unnecessary delays in providing veterans with the benefits they
    deserve.
        A law passed in 1941 liberalized the requirements for proof of
    service-connection in cases involving veterans who participated in
    combat. Under this existing law, veterans who can establish that they
    participated in combat do not have to produce official military records
    to support their claim that their disabilities or injuries are service-
    connected.
        However, a Department of Veterans Affairs General Counsel opinion
    issued in 1999 requires veterans to establish by official military
    records or decorations that they ``personally participated in events
    constituting an actual fight or encounter with a military foe or
    instrumentality.'' Under this opinion, some veterans are being delayed
    or denied compensation for combat injuries because they are unable to
    produce official military documentation--like certain medals, unit
    reports, or news reports--proving their personal participation in a
    specific combat incident.
        While the VA accepts certain medals as proof of combat, only a
    fraction of those who actually participate in combat receive a
    qualifying medal. In addition, making, maintaining, and transmitting
    records in combat zones can be difficult and chaotic, and military
    records usually do not document actual combat experiences.
        Mr. Chairman, I believe that the last thing our wounded veterans
    returning home from war should have to do is engage in another battle
    with the VA to prove that they were wounded in a specific incident in
    order to receive disability benefits. How can the VA conscionably force
    a veteran suffering from Post-Traumatic Stress Disorder (PTSD), or from
    a physical injury incurred in combat, to track down official proof--
    proof that may not even exist, considering the poor records keeping in
    combat zones--of their engagement in battle? How can the VA force
    wounded veterans to wait indefinitely for help as the VA conducts
    research to determine whether the veteran's unit engaged in combat?
        This requirement is just one more example of an unnecessary
    bureaucratic barrier, another piece of arbitrary red tape, which our
    wounded veterans must face. I am especially concerned with this
    bureaucratic hurdle because, as we saw at the Oversight and Government
    Reform Committee hearing at Walter Reed last year, the layers and
    layers of VA and DoD bureaucracy directly contributed to the systemic
    breakdown and the mistreatment of veterans there. Unless we start to
    peel away these bureaucratic layers, I'm afraid we are in danger of
    repeating the shame of Walter Reed and denying veterans the treatment
    and benefits they deserve.
        Indeed, unnecessary red tape and unnecessary delays in receiving
    benefits continue to plague veterans all over the country, and continue
    to be identified by veterans and those who work with them as one of the
    most significant problems facing returning veterans today. The
    astounding number of backlogged VA benefits claims--currently over
    648,000--is evidence of this problem. I am concerned that this number
    is only going to increase as more veterans return from the wars in Iraq
    and Afghanistan unless we address some of these paperwork and
    documentation problems. The Compensation for Combat Veterans Act would
    do just that: VA Regional Offices have estimated that the passage of
    this bill would speed up their claims processing by weeks.
        David Woods, the Director of Veterans Affairs for Scott County,
    Iowa, who is testifying before the Subcommittee today, estimates that
    he has helped 75-100 injured veterans who have had problems proving
    that they were injured in specific combat incidents. This includes
    veterans returning from Iraq and Afghanistan, as well as Vietnam
    veterans experiencing PTSD triggered after several decades by the
    current wars. As David has said, soldiers engaged in combat are often
    from several different units and do not know who is there fighting
    along with them when a battle breaks out. Soldiers engaged in combat
    are focused on survival--not documenting where and when the battle is
    taking place.
        My office has also worked with at least one veteran who has
    experienced this problem. This veteran came to my office last August
    asking for assistance with his service-connected disability claim for
    his wounded shoulder and other injuries. Though the VA treated his
    shoulder, since his medical records from Iraq are missing, the VA won't
    approve service-connection. This veteran has served two separate
    deployments in Iraq, and I believe that it is unacceptable that he is
    being denied the benefits that he deserves.
        That is why I believe it is so important to pass the Compensation
    for Combat Veterans Act. My bill would overturn the VA General Counsel
    precedent opinion, and allow for utilization of non-official evidence
    as proof of in-service occurrence for establishing service connection
    of combat-related diseases and injuries. This bill would eliminate the
    requirement for further evidence in cases in which a veteran can
    demonstrate service in a recognized combat area, alleges disabilities
    related to their service in that combat area, and has a disease or
    injury consistent with the circumstances, conditions, or hardships of
    their service in that combat area. This bill would lower the
    evidentiary standards for veterans suffering from physical injuries, as
    well as from mental wounds like PTSD or Traumatic Brain Injury, the
    hidden and hallmark wounds of the wars which often do not materialize
    for months after a veteran has returned home.
        Again, thank you for allowing me to testify in support of the
    Compensation for Combat Veterans Act today. I hope that the
    Subcommittee and full Veterans Affairs' Committee will act quickly to
    move this important legislation forward to ensure that combat veterans
    receive the benefits they deserve in a timely manner.

                           Statement of Kerry Baker,
      Associate National Legislative Director, Disabled American Veterans

        Mr. Chairman and Members of the Subcommittee:
        On behalf of the 1.3 million members of the Disabled American
    Veterans (DAV), I am honored to present this testimony to address
    various benefits bills before the Subcommittee today. In accordance
    with our congressional charter, the DAV's mission is to ``advance the
    interests, and work for the betterment, of all wounded, injured, and
    disabled American veterans.'' We are therefore pleased to support
    various measures insofar as they fall within that scope.

                                   H.R. 1197

        The ``Prisoner of War Benefits Act of 2007'' (H.R. 1197),
    introduced by Congressman Bilirakis in February 2007, would provide
    improved benefits for veterans who are former prisoners of war (POW).
    Specifically, H.R. 1197 would repeal the minimum period of internment
    for presumptive service connection for diseases associated with POW
    status. The bill would also add type 2 Diabetes and osteoporosis to the
    list of diseases presumptively associated with POW status. The DAV has
    a standing resolution to support the expansion of benefits for former
    POWs; therefore, we support this bill.
        The bill also authorizes the Department of Veterans Affairs (VA) to
    establish additional diseases as presumptively related to a veteran's
    POW status. Such authorization instructs the VA to establish a new
    disease as presumptively related to POW experiences whenever credible
    evidence for the association is equal to or outweighs the credible
    evidence against the association. The DAV feels this criteria is very
    fair considering that a disease may not be considered presumptive
    unless evidence as a whole suggests no relationship and that such
    evidence is not outweighed by evidence that does suggest a
    relationship. The Nation's former POWs have earned no less.

                                   H.R. 3008

        The ``Rural Veterans Services Outreach and Training Act'' (H.R.
    3008), introduced by Congressman Wu in July 2007, is meant to improve
    services to veterans residing in rural areas. The bill proposes to
    improve outreach and assistance to veterans, their dependents, and
    survivors through training of rural county veterans' service officers
    (CVSOs). The bill proposes to do this by making competitive grants to
    provide financial assistance to state departments of veterans affairs
    wherein the grants are determined by the Secretary of Veterans Affairs
    (Secretary) but shall not exceed $1,000,000.
        The DAV is concerned that providing Departmental funds to train
    CVSOs may not be the best use of such funds. Nonetheless, the DAV has
    no resolution on this issue and we therefore take no position on the
    bill.

                                   H.R. 3070

        The ``Disabled Veterans' Caregiver Compensation Act'' (H.R. 3070),
    introduced by Congressman Peterson in July 2007, would authorize
    additional compensation, in the amount of $234.00, to be paid to
    certain veterans in receipt of compensation for a service-connected
    disability rated totally disabling for whom a family member dependent
    on the veteran for support provides care. This extra compensation would
    be paid ``[i]f and while rated totally disabled and in need of regular
    aid and attendance and while unpaid aid and attendance is provided by
    an adult family member who is dependent upon such veteran for support.
    . . .''
        The DAV supports this bill--we applaud it. However, clarification
    is needed. Title 38 defines ``child'' and ``parent'' as they relate to
    various veterans' benefits. Title 38 does not define ``dependent'' for
    benefits administered by the Secretary. Without such a definition, at
    least concerning the amendments made by this bill, it will be unclear
    who qualifies for this benefit. For example, an adult child caring for
    a veteran described by this bill may qualify as an ``adult family
    member'' but still not qualify as ``dependent upon such veteran'' if
    the child were not financially dependent on the veteran. Such a child
    could not qualify as a dependent, even if he/she had to relinquish
    employment in order to care for the parent because the child may no
    longer qualify as a ``child'' for VA purposes.
        We do not believe the bill's intent is to exclude those in the
    above scenarios, as well as others. Therefore, while we fully support
    the bill, we request the bill be amended to properly define who does
    and does not qualify for the benefit provided by the bill.
        Additionally, the amount of compensation listed herein ($234) is
    equal to the amount of compensation listed in section 1115 payable to a
    veteran with a spouse in need of aid and attendance. If this figure is
    no coincidence, which we do not believe to be the case, we must note
    that $234 is the figure for 2002. We asked that the bill be amended to
    reflect the current year's level of compensation.

                                   H.R. 3795

        The ``You Were There, You Get Care Act of 2007'' (H.R. 3795),
    introduced by Chairman Filner in October 2007, would provide that
    veterans of service in the 1991 Persian Gulf War and subsequent
    conflicts shall be considered to be radiation-exposed veterans for
    purposes of service connection for certain diseases and disabilities,
    and for other purposes. This bill would provide presumptive service
    connection for any ``disease that is covered under section 3.309 or
    3.311 of title 38 of the Code of Federal Regulations and any other
    disease found by the Secretary to result from exposure to depleted
    uranium or the by-products of the burn-off that occurs when a depleted
    uranium munition penetrates a target. The DAV supports this bill.
        Those veterans covered by this bill are those that served during
    the Persian Gulf War or any subsequent conflict in which depleted
    uranium munitions are used, if that service is in the theater of
    operations of that war or conflict or involved the clean-up or
    servicing of vehicles or equipment that had been in such a theater of
    operations. The DAV does not have a standing resolution directly on
    point with this bill, we do however have resolutions calling for the
    support of enhanced benefits for Persian Gulf War veterans suffering
    from diseases associated with their service. Therefore, the DAV fully
    supports this bill.

                                   H.R. 4274

        The ``Gold Star Parents Annuity Act of 2007'' (H.R. 4274),
    introduced by Congressman Walsh in December 2007, would provide for the
    payment of a monthly stipend to the surviving parents (known as ``Gold
    Star parents'') of members of the Armed Forces who die during a period
    of war. The DAV has no opposition to this bill.
        This bill would require the Secretary to pay a monthly pension to
    each person who has received a gold star lapel button under section
    1126 of title 10 as a parent of a person who died in a manner described
    in that section. The total amount of payment to a Gold Star parent
    would be $125. If there is more than one eligible parent, the total
    amount would be divided equally among the eligible parents.
        While the DAV has no opposition to this bill, we do not believe
    that $125, or $75 dollars each for two parents is adequate. These
    amounts cannot begin to honor the depth of a parent's sacrifice when
    their child, perhaps their only child, is lost forever on a distant
    battlefield. Death on the battlefield is unquestionably the greatest
    sacrifice a servicemember can make for his or her country, but it is
    also the greatest sacrifice that a parent can make. Therefore, while we
    respect the intent of this bill and thank Mr. Walsh for its
    introduction, we respectfully request the monetary amount described
    herein be substantially increased.

                                   H.R. 5155

        The ``Combat Veterans Debt Elimination Act of 2008'' (H.R. 5155),
    introduced by Congresswoman Shea-Porter in January 2008, would prohibit
    the Secretary from collecting certain debts to the United States in the
    case of veterans who die as a result of a service-connected disability
    incurred or aggravated on active duty in a combat zone. The DAV has no
    resolution on this issue, which is essentially outside our mission
    scope. Therefore, we take no position on this bill.

                                   H.R. 5448

        The ``Full Faith in Veterans Act of 2008'' (H.R. 5448), introduced
    by Congressman Allen in February 2008, would seek to improve the
    disability compensation evaluation procedures for veterans with post
    traumatic stress disorder and to improve the diagnosis and treatment of
    post traumatic stress disorder. The DAV has no opposition to this bill;
    in fact, we are on record as staunch supporters of a similar bill, H.R.
    5892.
        H.R. 5892 accomplishes many of the same goals as this bill and has
    already been moved out of Committee and into the full House. H.R. 5892
    is also more comprehensive than H.R. 5448, while achieving the same
    goals as this bill. Because of this, and even though we do not oppose
    this bill, we respectfully request that any resources that Congress
    would otherwise spend on this bill be diverted to support the passage
    of H.R. 5892.

                                   H.R. 5454

        Congressman Brown introduced H.R. 5454 in February 2008. This bill
    would establish a presumption of service connection of amyotrophic
    lateral sclerosis for purposes of the laws administered by the
    Secretary. Essentially, this bill would amend section 1112 of title 38,
    United States Code, to provide for a presumption of service connection
    for amyotrophic lateral sclerosis when developing to a 10 percent
    degree of disability at any time after service. Although the DAV has no
    resolution on this issue, because of its positive impact on disabled
    veterans and their dependents, as well as the higher prevalence of this
    disease among the veteran population, we support this bill in full.

                                   H.R. 5709

        The ``Veterans Disability Fairness Act'' (H.R. 5709), introduced by
    Congressman Space in April 2008, would require the Secretary to carry
    out quality assurance activities with respect to the administration of
    disability compensation. In order to carry out the quality assurance
    program under section 7731 of title 38, United States Code, with
    respect to the administration of disability compensation, this bill
    would require the Secretary to ensure accuracy and consistency across
    different offices within the Department of the treatment of claims for
    disability compensation, including determinations with respect to
    disability ratings and whether a disability is service connected.
        For each disability compensation claim, this bill would require the
    Secretary to track and monitor the following: (1) The state in which
    the claimant resided when the claim was submitted; (2) the decision of
    the Secretary with respect to the claim; (3) the regional office and
    individual employee of the Department responsible for evaluating the
    claim; (4) if the claim was adjudicated, the results of such
    adjudication; (5) the state of the claimant's residence; and (6) such
    other data as the Secretary determines is appropriate for monitoring
    the accuracy and consistency of decisions with respect to such claims.
    Once compiled, the Secretary would be required to use this information
    to conduct annual reviews to correct any inaccuracies or
    inconsistencies in disability ratings and the adjudication of claims
    for disability compensation. Such reviews and audits shall evaluate
    disability ratings and claims adjudication by regional office and by
    the employee responsible for each such rating or adjudication
        The DAV has long advocated for enhanced quality assurance and
    oversight of VA's disability claims processing system. We therefore
    support this bill and applaud Mr. Space for its introduction.

                                   H.R. 5954

        Congressman Thompson introduced H.R. 5954 in May 2008. If enacted,
    this bill would provide veterans with presumptions of service
    connection for purposes of benefits under laws administered by the
    Secretary for diseases associated with service in the Armed Forces and
    exposure to biological, chemical, or other toxic agents as part of
    Project 112. This bill is one that all disabled veterans who were
    unknowingly harmed by military experiments and wrongfully denied
    disability benefits to which they were legally entitled should
    celebrate.
        This legislation will only be successful if the Department of
    Defense (DoD) releases the names of all participants of these military
    experiments, many of which may not even be aware of their involvement.
    For this reason, the DAV is pleased that this bill requires the DoD to
    release the information vital for the success of this bill. Without
    such a requirement, those affected by these unthinkable experiments
    will continue to be locked out of a system otherwise designed to
    provide the help this bill delivers.
        Since 2003, the DoD has stopped actively searching for individuals
    who were potentially exposed to chemical or biological substances
    during Project 112 tests, but have not provided any basis for that
    decision. In 2003, the DoD reported it had identified 5,842
    servicemembers as having been potentially exposed during Project 112,
    but also indicated that it would cease searching for additional
    individuals. In 2004, the government Accountability Office (GAO)
    reported that the DoD did not exhaust all possible sources of
    information.
        Since June 2003, however, non-DoD sources--including the Institute
    of Medicine--have identified approximately 600 additional names of
    individuals who were potentially exposed during Project 112. This fully
    supports the proposition that the DoD's actions were completely
    arbitrary. Until these issues are addressed, veterans will remain
    unaware of their potential exposure, and this monumental injustice of
    experimentation on U.S. servicemembers will continue to go unanswered.
    Congress must mandate that the DoD live up to its obligation of
    identifying every single veteran that may have had even the smallest
    potential of exposure. This bill is a large step in the right direction
    and the DAV supports it.

                                   H.R. 5985

        The ``Compensation for Combat Veterans Act'' (H.R. 5985),
    introduced by Congressman Braley in May 2008, would clarify service
    treatable as ``service engaged in combat with the enemy'' for
    utilization of non-official evidence as proof of service connection in
    a combat-related disease or injury. The DAV supports this bill;
    however, we suggest amendments. This legislation establishes that a
    veteran who ``during active service . . . served in a combat zone for
    purposes of section 112 of the Internal Revenue Code of 1986, or a
    predecessor provision of law, shall be treated as having engaged in
    combat with the enemy in active service for purposes of that paragraph
    during such service in that combat zone.'' The legislation as currently
    written would allow, for example, an Iraqi War veteran who only served
    in Bahrain and was consequently never in danger of being exposed to
    combat, the same consideration as an Iraqi War veteran who served
    inside the combat theatre of operation.
        We therefore suggest an amendment to this legislation that would
    still consider a class of veterans as having been exposed to combat,
    but suggest that those veterans with service inside the borders of the
    combat theatre of operation receive such consideration, such as those
    serving inside the borders of Iraq, Afghanistan, Vietnam, etc.

                                   H.R. 6032

        Congressman Filner introduced H.R. 6032 in May 2008. The bill would
    direct the Secretary to provide wartime disability compensation for
    veterans who served in the Republic of Vietnam and who have manifested
    Parkinson's disease to degree of 10 percent or more. The DAV is
    certainly not opposed to enhancing benefits for veterans who served in
    the republic of Vietnam. However, currently we are unaware of
    scientific evidence suggesting a positive association between
    Parkinson's disease and exposure to herbicides. Therefore, the DAV
    takes no position on this bill. If, however, such scientific evidence
    becomes available, or we are otherwise made aware of its existence, we
    will fully support this legislation.
        Mr. Chairman, this concludes my testimony on behalf of DAV. We hope
    you will consider our recommendations.

                         Statement of Susan R. Frasier,
                  Albany, NY (Disabled Veteran), on behalf of
                   Fort McClellan Veterans Stakeholders Group

        Thank you Mr. Chairman, for allowing us to make a brief appearance
    in writing for the record, and to speak on some of the breakthrough
    bills which appear on your docket today. Our remarks will be directed
    to H.R. 5954 which provides a long awaited justice to our military
    brothers of the Project 112 ship tests during the Cold war Era, and
    also to H.R. 3795 for the veterans of the Gulf War.
        I am the lead activist for the Fort McClellan Veterans Stakeholders
    Group. We formed this group in 2003 to advance our own pursuits for
    legislation and justice inside the VA disability system. We are mostly
    medical and disability patients who have served at Fort McClellan,
    Alabama from 1955 to 1978. We hold the Cold war Service Medals issued
    under the Clinton administration from years past. We do consider
    ourselves to be chemical exposure victims from our service at the base,
    and we can speak in verification about the ordeal the current VA
    disability system poses to any new and incoming Veterans who identify
    themselves as known or suspected exposure cases, regardless of the
    source.
        We applaud, endorse, and support the victories which are
    represented in your bills today by H.R. 5954 and H.R. 3795. Those
    exposure groups have worked long and hard along side our own group, to
    receive this day of justice in their names. The tests of Project 112
    and its loosely related counterpart, more commonly referred to out here
    in our Veterans arena as the Edgewood tests, were in some ways a freak
    of the times. We can only wonder what the military authorities were all
    thinking when they subjected these brave volunteers to various forces
    of contamination and then walked away without providing them with
    adequate followup reviews for medical tracking or to give them
    prioritized disability standing in the VA medical system.
        For our Gulf War counterparts, they too have been put through an
    ordeal that was prolonged, unnecessary, and preventable if only the VA
    had a working ``rapid response'' system in place to activate temporary
    support services while their Presumptive statuses were pending.
        The simple fact that it requires an act of Congress to rescue
    verified contamination medical patients inside the current structure of
    the VA disability system, speaks volumes about the ordeal that so many
    of us have been put through.
        While we are relieved, happy, and gratified that H.R. 5954 has
    finally arrived for our military brothers of Project 112, we caution
    that the rest of the Edgewood test population still should be addressed
    by separate legislation, and when that happens, our group will then
    exert a vested interest in that outcome too.
        Fort McClellan, Alabama from the years 1955 to 1978, also
    represents a freak of the times, and poses a new and unique situation
    to this legislating body of Congress. It is a situation which has never
    before been seen in the history of veterans disability claims. During
    the same and simultaneous time span of years, Fort McClellan was not
    only a part of the Edgewood series of open air chemical tests on the
    grounds of the base itself, but also, the same base was surrounded by a
    massive, PCB contamination zone by the nearby Monsanto chemical factory
    of it's day in our recreation district of downtown Anniston, Alabama.
    The PCB zone contaminated the air, the water, and the soil of much of
    the surrounding region leading up to the base, even though today's
    reports from the Environmental Protection Agency only addresses the
    modern day concerns and tests of the water and soil.
        The rate of spew from the broken Monsanto air stacks, based on our
    computations made from the original notes of the Monsanto pollution
    engineers back in the day, amounted to over 2,000 tons per month
    released into the air back in the day. Then in addition to that, the
    EPA has estimated the cloud cover from that spew to have an extended
    overhead smog life of 10 days in lingering. This is to say that the
    thousands of pounds of PCB's that spewed into the air on any 1 day,
    also remained overhead in that same region for yet another 10 days in
    lingering before releasing and dispersing out into the general
    atmosphere away from the geographic location. Then this overhead
    lingering was added into by yet more spew.
        Simultaneously, and without the knowledge of the nearby Monsanto
    disaster that was in the works, persons assigned to the Edgewood Cold
    war Era tests at Fort McClellan were conducting open air chemical tests
    on the base itself. These tests were done with inadequate attention
    applied to the protection of those volunteers who were actually in the
    tests, and with no protection whatsoever to those of us who were at
    other locations on the base and not involved in the tests. This was the
    time of the Vietnam War training maneuvers, which included Pentagon-
    mandated gashouse training which involved the removal of face masks
    inside of active (CN) and (CS) gas discharges so that we could be war
    certified in completion of our boot camp training.
        We have contended that anyone of these exposure sources, or any
    combination of them in the hereafter, may be the causation of our
    modern day disabilities and diseases. We may actually be the very first
    known medical population to enter the military and VA system to declare
    ourselves as a ``bystander'' exposure population since we never knew
    the cause of either of these contamination scenarios.
        So you can see here the similarity of concerns and experiences that
    we bring to the legislative table when offering up our support and
    sympathy to our Project 112 military brothers and our counterparts of
    men and women from the Gulf War.
        The VA has been unresponsive to all of these exposure populations
    up until today, so it brings us a great sense of hope and celebration
    today to see with our own eyes, this day of victory and justice which
    is embodied in your bills of H.R. 5954 and H.R. 3795.
        The Department of Veterans Affairs should undergo massive
    reorganization to position themselves for the future to serve and
    support all hazardous exposure military veterans, regardless of the
    source of their exposure. The current VA system is broken beyond repair
    and sadly, there is not even a showing of interest in repairing it
    whenever we have approached Washington VA officials for resolve.
        The VA uses deprivation of services as the first course of action
    whenever they are approached by a new population of veterans who are
    suspecting themselves to be hazardous exposure medical patients.
    Without intervening legislation from Congress, their mistake will not
    likely be fixed. The VA has no understanding at all of the meaning of
    ``emergency response.'' They will stand around in a spirit of inaction
    and delay, and literally allow veterans to die or have their hands
    forced into suicide from the prolonged suffering they endure, rather
    than to eat the embarrassments of correction and apology for their
    bureaucratic mistakes.
        At the Fort McClellan contamination zone, the veterans who served
    there are medically matched to the nearby civilian population, and yet
    even with this stunning development to our advantage, the VA holds onto
    their delay practices, their deprivation of services, and their no
    assistance to our service group as medical patients.
        In some ways, Project 112 and the related Edgewood tests are a
    symbol of what is also wrong at the VA. All of these matters are an
    outcome of excessive proofing requirements gone amuck. There reaches a
    point in most rational acts, where relentless questioning, unending
    verifying, and proofing above and beyond the norms of medical
    scenarios, (and the relentless demanding of the same), crosses a line
    beyond the normal limits of proper reason and travels straight over
    into a dark side where most of us would never go. There are people in
    this world who will spend all of their days questioning life itself:
    but that does not mean that the rest of us all have to go along for the
    ride.
        The VA requires individual medical patients to shed themselves of
    their hospital standing, and become mini-agencies in their own name to
    prove up, answer up, comply up, and provide the tonnage of science,
    medical, classified, unclassified, military, unmilitary, hospital and
    even childhood documents just to prove that which every other rational
    American in this country can blatantly see with their own eyes as true.
    We say, that this all has to stop, in the name of saving the lives of
    Veterans. Proofing of disease and disability, at the level of extremes,
    excessiveness, and over the top--even when the same logical conclusion
    is as plain as day to everyone else who reviews a veterans case, is
    causing the premature deaths of our veterans and it is causing them to
    die with no service connected benefits in place at all.
        Lack of information, concealment of information, and especially the
    absence of official NOTIFICATION to Veterans who may have been exposed
    to hazardous sources, wreaks havoc throughout the entire chain of
    process in both the VA and the Social Security systems. Veterans are
    first not officially notified of their exposure circumstances, and then
    are also burdened with elaborate and complicated ``nexus theories'' to
    succeed either in their individual disability claims or their pursuits
    for patient class recognition, which is known in the VA system as
    Presumptive Service Connected statusing.
        Official notification to Veterans who have come into contact with
    any potential contamination source during their military service, must
    be integrated into all legislation and policy changes at the VA because
    it is crucial information that we have to pass along to our caregivers.
    It is vital deciding information that a practicing physician weighs
    upon during the moment of diagnosis for these veterans. So notification
    must be treated equal in importance to all other features of rescuing
    hazardous exposure veterans at the VA.
        The VSO's do complicate this ordeal situation even further for us.
        Instead of taking on the system to force the VA to reorganize
    themselves into an ``emergency response'' program to intake and serve
    these exposure veterans, the VSO's force veterans to endure years of
    process to comply with the wholly malpracticed systems which the VA
    currently has in place.
        I have fired VSO's one by one in my own case for this very reason.
    Furthermore, VSO's only provide case-in-a-box assistance for claims.
        Claims which are far more complicated, and not as cut and dried as
    the run of the mill, case-in-a-box, which are presented to them, are
    simply refused assistance by the VSO's due to complexity and their
    inability to either comprehend the details of the case, or their
    inability to construct fast and simple workarounds to the barriers put
    up by the VA. Also, if they do accept the case for VSO handling the
    veterans are subordinated to unqualified and incompetent case people
    who are in over their heads and don't know it. In the end, these
    exposure cases in some cases, not always, remain unassisted by VSO's.
        We have repeatedly gone out to VSO's to obtain help for our Fort
    McClellan advocacies only to have the door slammed in our faces with
    either a wall of silence, (much like what the VA does), or a lousy
    ``thank you for sharing'' letter to facilitate the VA's agenda of delay
    until death. I am almost 60 years old and mobility impaired with
    muscular disease and yet even identifying myself with that, VSO's have
    sided with the nonsense processes of the VA and not with us.
        We consider ourselves to be holding matching and textbook disease
    patterns to be commonly recognized markers held in all other chemical
    exposure populations. But it is only the VA who stands around spinning
    its wheels on process and burdening us with delay.
        Among the list of those refusing to help us as VSO's includes DAV,
    American Legion (Albany & Washington, DC), VFW, the WAC Veterans
    Association, Vietnam Veterans of America (the Womens Committee) the
    National Veterans Legal Services Corporation and the Veterans Pro Bono
    Consortium. Among those who have refused assisting us at the VA
    includes Dr. Mark Brown, Irene Trowell-Harris, the Center for Women
    Veterans, Comp & Pen, and the VA Secretary's Office himself. At the
    Dept. of Defense, the Office of Health Deployment sent us directly to
    the VA and would not talk to us any further after passing us to VA
    hands.
        Among other things, the VA also forces medical patients to
    ``incorporate'' as non-profit corporations just so they can obtain
    legislative or medical recognition as a patient group class. We say for
    the record that we are opposed to such practices and insist here before
    you today, that these larger systemic issues of the VA be mandatorily
    halted in the future. To say to a body of medical patients that their
    only hope of advancing medical assistance is to form a corporation and
    become a company is just plain nonsense and is contrary to the
    treatment advisory of licensed medical practitioners.
        The Veterans Disability Benefits Commission of 2007, in their
    report to Congress in Chapter 5, has found in our favor as medical
    patients and has found against the practices of the VA. In combination
    with the Institute of Medicine and the Center for Naval Analysis, they
    have concluded that the Fort McClellan Veterans, whether involved in
    Edgewood tests or by their exposures to the Monsanto PCB contamination,
    should receive their day of legislative justice along with our
    counterparts represented in the bills before you today. They have also
    concluded that the VA's current process for Presumptive Service
    Connected statusing, should be wholly revised and undergo massive
    correction. Our Stakeholders Group did participate in the VDBC hearings
    and we gave our endorsements to these findings and conclusions when
    those topics came up for a floor vote by them. We implore upon you now
    to please change the VA presumptive system.
        There are 2 simple questions to be answered in all of this as I
    present it to you today:
        How much is ``enough'' for VA medical patients to have to endure
    without any assistance or services?
        And also,
        Why do individual medical cases have to endure excessive and over
    the top proofing requirements in exposure scenarios when the Dept. of
    Justice has already litigated cleanups on behalf of the Environmental
    Protection Agency for the nearby civilian population?
        These are fair questions to know and I bring them to you today in
    the name of our Stakeholders Group.
        I am not the U.S. Department of Susan R. Frasier, so why is the VA
    treating me as if I am a well-funded, fully staffed, and mobilized
    government agency without any health impairments?
        The Duty To Assist clause in the 38 CFR is also a complete disaster
    for us. All it does is allow the VA to obtain documents which actually
    verifies our cases, (without us ever seeing those documents first), and
    then gives the VA (not the veteran) the litigating advantage to turn
    around and use those documents against us to further deny the cases. In
    other words, if there is a mistake in the papers which the VA
    retrieved, then the individual medical patient is blamed for that
    mistake.
        In my own case, VARO Manhattan has sought to blame me personally
    for the fact that the Monsanto contamination zone in Alabama was never
    made publicly known until the late nineties. It is very much a matter
    of record that I was denied my 36 year old disability backlogged case
    because the Army failed to show in my hospital records that I was
    exposed at the Monsanto chemical zone, even though I had sent alternate
    information proving to the VA that the contamination was in the air
    during my army service.
        All of official Washington appears to be unanimous in their voices
    that the VA systems of now are in dire need of change and correction.
    The VA has possessed the VDBC Commission report to Congress since
    October of 2007, and they have possessed Chapter 5 specifically since
    January 8, 2008 when I hand delivered it to the VA Secretary's Office
    in Washington. And yet here we are 5 months later with no assistance
    and no change and no legislation from the VA Secretary to this very
    minute.
        Congress must look at the VA claims system with new eyes as if you
    are riding in a helicopter overhead to see the big picture.
        In medical environments, there reaches a point where excessive and
    unnecessary process must be set aside in the name of good medicine and
    fair justice.
        The proofing and evidencing requirements that we are burdened with
    as medical patients in the VA are extreme, excessive, over the top, and
    used only for purposes of delay and the causation of our premature
    deaths. It is done to literally stress and strain a genuinely sick
    veteran straight into his or her early grave with upset, despair, and
    relentless continuation in the scourge of poverty. These are inhumane
    practices which are done for the purpose of gaining legal advantage in
    a VA-sponsored disability litigation environment, and we call for its
    swift and decisive end. No other hazardous exposure veteran should have
    to endure what all of us have been forced to endure at the hands of the
    VA.
        We send our love, our celebration, and our salutes, to our military
    brothers of Project 112 and to our counterparts of the Gulf War era.
    Their ordeal and odyssey is now over and not a minute too soon either.
    We share in their important victory.
        We thank this Congress today, and to all who contributed to the
    development of H.R. 5954 and H.R. 3795 for the wisdom and rescue that
    both of these bills hold. We ask that you include ``notification to
    veterans'' in bills such as these in the future, to mandatorily require
    the VA to issue a letter and make an appropriate outreach effort to
    advise effected veterans that they have served in a potential
    contamination area. This notification is vital to the family
    information of those medical patients who are affected by contamination
    scenarios.
        And we call upon Congress to continue its important work on these
    matters of intervention, correction, and emergency for all other
    remaining hazardous exposure patient groups, including the Fort
    McClellan Veterans, who remain hopelessly trapped in a VA system that
    is broken, uncaring, and unserving to all who identify themselves as
    potential new exposure cases.
        Also Signed in Support, The Following Members of our group:

    Carolyn Tyler--Wisconsin
    Kathy Warren-Miller--Texas
    Sandra Ashley--Washington
    John Snodgrass--Alabama
    Nancie Smith--Florida
    Ellen O'Neill--Ohio
    Carolyn Arnold--Ohio
    John Kamps--Texas
    Janie Lehman--Pennsylvania
    William Brawley--North Carolina
    Wanda Seay--California
    Nancy Gower--Indiana

        The remaining members of our group wish to remain anonymous.

         Statement of Commander Norman C. Lachapelle, MSC, USN (Ret.),
        Administrator, Bureau of Environmental Health/Emergency Regional
           Response, Memphis and Shelby County Health Department, TN

        Chairman Filner, Ranking Member Buyer and Distinguished Members of
    the Committee. My name is Norman C. Lachapelle and I live in Memphis,
    Tennessee. I am a retired Commander, Medical Service Corps, U.S. Navy
    and presently Administrator, Bureau of Environmental Health/Emergency
    Regional Response Coordinator with the Memphis and Shelby County Health
    Department in Tennessee.
        I received orders to Project SHAD Technical Staff on board USS
    Granville S. Hall (YAG-40) in May 1965. My duty assignment was senior
    microbiologist and later technical operations officer charged with
    overseeing the microbiological and chemical functions in support of
    Deseret Test Center (DTC) SHAD tests. I served in that capacity until
    1970 interrupted by a 12-month deployment in Vietnam in 1967.
        In addition to the Division of five (5) light Tugs as described by
    the officer in charge's testimony, the technical staff of SHAD
    consisted of experienced Navy microbiologists, hospital corpsmen,
    laboratory technicians, gunners mate, meteorologists and photographers.
    This group was responsible for:
          Preparing and calibrating air monitoring equipment used
    on the five (5) Light Tugs that served as aerosol sampling platforms
    during open-air sea tests conducted with biological and chemical
    simulant released agents.
          Conducting quality control of ``munitions'' i.e.,
    concentration of agent slurry used for aerosol dispersal from military
    jet aircraft.
          Analyzing test samples collected from Light Tugs for
    quantitative and qualitative microbiological evaluations.
          Preparing a summary of raw laboratory qualitative and
    quantitative analytical results and data submitted to DTC Test Director
    after the completion of each test trial. These data revealed the
    concentration of agents collected in the Light Tug laboratories after
    each test trial.
        For the most part, technical staff participants were informed of
    the nature of the tests, standard operating procedures and trained in
    precautionary safety techniques using best available practices in the
    1960's. In retrospect, based on my experience with DTC-SHAD sea and
    land base tests, more stringent safety measures should have been
    reinforced involving so called ``harmless'' simulants such as
    Escherichia coli (E-Coli) and Serratia marcescens (SM) which are now of
    medical concern and no longer used by military in biological aerosol
    testing. Most disturbing is the fact that in 1950 the Army sprayed SM
    off the Coast of San Francisco, and shortly afterwards patients at
    Stanford University Hospital began appearing with Serratia marcescens
    infections. This should have been a wake up call on the use of SM and
    other biologicals as simulants.
        Bacillus globigii (BG) was used as a simulant in the majority of
    DTC tests. However, BG, as reported in the Institute of Medicine (IOM)
    long-term health effects of participants in Project SHAD study report,
    is now considered a pathogen for humans.
        Of great concern was the application of beta-propiolactone (BPL)
    disseminated as a mist to decontaminate the interior of ships including
    the Light Tugs. The procedure involved sealing the vessel after the
    crew was evacuated and releasing the BPL from an electrical vaporizer
    for a period of time sufficient to destroy microorganisms. To my
    knowledge the concentration of BPL was not recorded or the testing of
    the interior spaces for residual BPL, to ensure safe re-entry. The
    International Agency for Research on Cancer (IARC) regards beta-
    propiolactone as a possible Carcinogen and cautions that a single dose
    of exposure is enough to pose a significant risk of cancer.
        It is important to mention that high level DoD officials testified
    at a Senate Armed Services Hearing in 2003 that DTC test records
    indicated that sailors were vaccinated against Paternella tularensis
    (Tularemia) and Coxriella burnetti (Q-Fever) and that the Army had
    vaccines against those agents. Neither of these vaccines were FDA
    approved and considered experimental vaccines. To my knowledge, a
    medical followup on the health status of the SHAD participants that
    were inoculated was not conducted and the type and dosage of the
    vaccine were not entered in their medical records.
        Regretfully, all information and data about SHAD tests remained
    classified until 2001 when DoD began sharing some declassified DTC test
    information with Veterans Affairs. SHAD veterans were certainly at a
    disadvantage during this time, i.e., over 40 years post termination of
    Project SHAD in not having this information available when being
    evaluated for proper health care. It is of great value and help for
    attending physicians to know as much as possible about concentrations
    of hazardous materials that their patients have been exposed to.
        It was a privilege and honor to have served with shipmates that
    were unquestionably dedicated in accomplishing the dangerous and highly
    classified mission of SHAD.
        The many Project 112/SHAD participants, who unselfishly and
    willingly exposed themselves to hazardous biologicals and chemicals,
    oftentimes with minimum personal protection, deserve the highest level
    of quality healthcare that this government can provide.
        I join the many Project 112 and SHAD Veterans in expressing a
    heartfelt appreciation for all the hard and consistent work that
    Congressman Mike Thompson has done in our behalf and for Congressman
    Rehberg for joining the task.
        I thank Chairman Filner, Ranking Member Buyer, and Members of the
    Committee, and herein respectfully request that H.R. 5954 be moved from
    Committee to the Floor of the House with the recommendation for
    approval.

                          Statement of John A. Scocos,
    President, National Association of State Directors of Veterans Affairs,
                                      and
              Secretary, Wisconsin Department of Veterans Affairs

        On behalf of the National Association of State Directors of
    Veterans Affairs, this letter is to express our strong support for the
    efforts of the U.S. House Committee on Veterans' Affairs and its work
    in advancing bills of great importance to current, past, and future
    generations of veterans.
        We appreciate you holding this important Committee hearing on these
    many issues. Our positions on these bills are as follows:
    H.R. 1197--Prisoner of War Benefits Act
        We support an expansion of presumptive service-connection benefits,
    liberalizing the requisite period of internment, and updating the
    determination of such presumption for former prisoners of war.
    H.R. 3008--Rural Veterans Services Outreach and Training Act
        We support H.R. 3008 only if it is substantially amended as
    follows. The current language of H.R. 3008 is an excellent starting
    point for continuing a growing dialog on the need for expanded outreach
    to our Nation's veterans, though it does not yet reflect the benefits
    and service delivery system of the majority of the states. We strongly
    support the creation of a statutory definition of outreach that ensures
    a systematic, proactive approach, and we support the definition of
    outreach as contained in H.R. 3008, which appears to mirror the
    language contained in S. 1315 as recently passed by the U.S. Senate and
    now awaiting House action. We also strongly support the creation of a
    federal grant program to the States for the provision of outreach.
        However, while we generally support the grant structure, grant
    amounts, and grant-making process in H.R. 3008, two areas of this bill
    should be amended to more closely match the variations in the veterans
    benefits and services delivery system that exist across the 50 states,
    the territories, and the District of Columbia (hereinafter referred to
    as ``the states'').
        First, while we concur that there is need in many rural parts of
    the Nation to provide outreach to veterans in rural areas, we recognize
    that many of the Nation's 24 million veterans live in areas that are
    not rural. We recently noted with interest the VA's telephone call
    outreach campaign to 570,000 of the 1.7 million veterans of the wars in
    Iraq and Afghanistan who have not yet utilized VA services--presumably
    a mix of rural, suburban, and urban. Veterans of the early years in the
    war in Iraq may not be aware of new testing and treatment for brain
    injury following blast exposure, post traumatic stress disorder,
    treatment for the self-medicating but self-defeating effects of
    substance abuse that may have only recently emerged, and so on. There
    is much to be done with regards to providing desperately needed
    outreach and services to our Nation's veterans, not just in rural areas
    of the Nation, and H.R. 3008 brings us part way to reaching that goal.
        Additionally, in the years following each war, Congress has
    successively expanded healthcare and other benefits programs to meet
    the needs of these warriors, including presumptive service-connection
    and healthcare enrollment and specialized treatment for various
    categories of veterans, including those with exposure to Agent Orange,
    ionizing radiation, Project 112 including Project SHAD, Gulf War
    illness, and for veterans who are ex-prisoners of war, purple heart
    recipients, veterans with service after 1998, and more. More needs to
    be done to reach out to these veterans as well, who are also presumably
    a mix of rural, suburban, and urban.
        As it is currently drafted, H.R. 3008 targets the grants
    exclusively to outreach workers who are employees of counties. Less
    than half the states, including Wisconsin, have benefits and outreach
    workers who are county employees, most typically called county veterans
    service officers (CVSOs). The language of the bill as it is currently
    written could certainly benefit these states. However, the majority of
    the states employ a variety of other models to provide services and
    outreach to their state veterans.
        In many of the states, there are service officers who are state
    agency employees, typically called state service officers, including
    Tennessee, New Mexico, and Illinois, whose Director of Veterans
    Affairs, Tammy Duckworth, testified before this Subcommittee a few
    weeks ago about her state's service state-employee service officers and
    the need for the creation of an outreach grant.
        A number of states contract with veterans service organizations
    (VSOs) to provide veterans services, like Utah, or with other types of
    non-profits, like Massachusetts.
        In some states, including in New York, municipalities and other
    non-county local governments provide direct veterans services and
    outreach.
        Many states, including Oregon, have a combination of several of
    these outreach mechanisms.
        The one thing all the states have in common is a state agency led
    by a director charged to serve all veterans within the geographic
    borders of the state. In order to effectively achieve the outreach
    goals outlined in this bill, it must be amended with language broad
    enough to cover veterans residing in all areas of the country in ways
    that are locally effective.
        The ability of State DVAs to provide Federal outreach funds to
    reach veterans in the respective states, either through a grant or
    through a contract, should continue to be allowed as under the original
    bill. Therefore, use of the term ``non-profits'' should be retained.
        To date, NASDVA has supported S. 1314, the Veterans Outreach
    Improvement Act and the language it contains. For the reasons noted
    above, NASDVA and the National Association of County Veterans Service
    Officers (NACVSO) agreed to recommend that the following language be
    included in S. 1314, which we believe more appropriately captures the
    totality of the Nation's infrastructure available for the provision of
    outreach to veterans nationwide:

            A veterans agency of a State receiving a grant under this
            subsection may use the grant amount for purposes described in
            paragraph (1) or award all or any portion of such grant amount
            to local governments in such State, other public entities in
            such State, or private non-profit organizations in such State
            for such purposes.

        Of note, the term ``non-profit'' includes VSOs, which are
    incorporated under one of the non-profit provisions of 501c of the
    Internal Revenue Code.
        H.R. 3008 is an important step in the right direction, and we
    appreciate the recognition of the need for more outreach and services
    by the bill's author, co-sponsors, and the leadership and Members of
    this Subcommittee in allowing today's hearing on this bill.
    H.R. 3795--You Were There, You Get Care Act
        We support the expansion of presumptive service-connected
    disability benefits to veterans who served in the Gulf War theater of
    operations and other military operations involving depleted uranium. We
    also support the independent medical study to identify other conditions
    in addition to those already covered under existing laws covering
    radiation.
    H.R. 4274--Gold Star Parents Annuity Act of 2007
        We support the creation of a stipend to surviving parents who are
    the recipient of the Gold Star lapel button.
    H.R. 5155--Combat Veterans Debt Elimination Act
        We support the prohibition of collections on indebtedness for
    military servicemembers who die of a service-connected disability
    incurred or aggravated on active duty in a war or combat zone.
    H.R. 5448--Full Faith in Veterans Act
        We support the implementation of new criteria for the service-
    connection of PTSD that reduces the burden of proof on the veteran and
    requires the consideration for the inclusion of treatment records that
    updates the provisions of the disability rating schedule regarding
    PTSD, traumatic brain injury, and other mental disorders.
    H.R. 5454--Presumption of service-connection for ALS
        Given the growing recognition of an inexplicable association of
    higher rates of amyotrophic lateral sclerosis among those with military
    service than those without similar service, we support the presumption
    of service-connection for ALS for wartime veterans.
    H.R. 5954--Presumption of service-connection for Project 112 veterans
        We support the presumption of service-connection for diseases
    associated with biological, chemical, or other toxic agents for
    veterans who were participants in Project 112, including Project SHAD,
    regardless of whether their participation was knowing or unknowing,
    willing or unwilling.
    H.R. 5985--Compensation for Combat Veterans Act
        We support the acceptance of records showing the veteran was
    entitled to combat zone compensation as proof of combat service of
    veterans for the purposes of certain veterans benefits. Given the
    nature of current military operations, it is highly possible that small
    groups of military servicemembers may be in combat operations and
    entitled to combat zone compensation exclusion, which may be the only
    publicly available evidence of their combat zone participation.
    H.R. 6032--Wartime disability compensation for certain veterans with
            Parkinson's disease
        Given the growing recognition of an inexplicable association of
    higher rates of Parkinson's disease among those with military service
    than those without similar service, we support the presumption of
    service-connection for Parkinson's disease for wartime veterans.

                          Statement of Denise Nichols,
        Vice Chairman, National Vietnam and Gulf War Veterans Coalition
                       National Vietnam and Gulf War Veterans Coalition
                                                        Washington, DC.
                                                          June 12, 2008

    To:
                HVAC Subcommittee Disability Assistance

    CC:
                House Veterans Affairs Majority Staff

    Subject:
                 Support for H.R. 3795--DU; H.R. 5954--BIOLOGICAL-CHEMICAL;
    H.R. 5454--ALS; H.R. 6032--PARKINSON

    Dear Representative Hall,

        Today your Subcommittee is marking up excellent legislation that we
    would like to wholeheartedly support. All the bills being brought up
    should be supported fully. The bills we are most interested in H.R.
    3795, 5454, 6032, 5954 are long overdue! Each of these bills address
    urgent needs. The Gulf War veterans have a particular interest in H.R.
    3795 and we are putting this on our hottest priority list! WE are
    already pushing more Representatives to sign on and show their support
    as cosponsors! We want these bills passed into law as fast as possible.
        Bills H.R. 5454 and 6032 address two devastating diseases and the
    veterans that are diagnosed with these need direct and immediate
    attention. The numbers of both within the VA system are not
    overwhelming and of course much lower than PTSD and the current combat
    injured (amputations, etc) but they probably need more support long
    term and that is the least we can do. We need to lift the burden of
    continued claims battles these veterans face and these bills will
    certainly serve to get them through that battle more rapidly so that
    they can not be burdened by additional fights when they need to focus
    on healthcare and battling to maintain their health as their central
    issue. We complement the VA House Committee for bringing them the first
    step in long term relief to the veterans that suffer these devastating
    illnesses.
        Bill H.R. 5954 the relief for Project Shad Veterans is long
    overdue. Again the number of these veterans is small as compared to all
    other groups and they have been forgotten for too long. We fully
    support this bill moving forward rapidly.
        We also support

    H.R. 1197--POW
    H.R. 5985--COMBAT VETERAN
    H.R. 5448--PTSD
    H.R. 5709--QUALITY CONTROL ON CLAIMS
    H.R. 5155---DEBT RELEASE
    H.R. 3008--RURAL CARE

        Thank you for your efforts to make a real difference for all
    veterans!

                Sincerely,
                                                 Denise Nichols
                                                  Vice Chairman

                     Statement of John E. Olsen, ET-2, USN,
                                  Billings, MT

        Chairman Hall, Ranking Member Lamborn and distinguished Members of
    the Committee. My name is John E. Olsen and I live in Billings,
    Montana. I am a former ETN-2 (64-65) and I write to describe my
    experiences within the ``Project SHAD Technical Staff'' (PSTS).
        I entered the U.S. Navy in 1961 after 3 years at Montana State
    University, including Advanced Army ROTC. After boot camp, I was
    assigned to ET `A' school for preparation as an Electronic Technician
    and assignment to the fleet. In 1964 I received orders to Project SHAD
    Technical Staff on board the USS Granville S. Hall for LT 2085. In
    normal transfers an enlisted person goes to the receiving station on
    the coast involved. In my case that should have been ``RECSTA Treasure
    Island'' in San Francisco bay. Instead, my orders were to the
    ``Presidio'' in San Francisco. A suite in a fancy barracks, and I did
    not see anyone else in the building while I was there. A few days here,
    then transported to Treasure Island and immediately bussed to the
    airbase to catch a MATS flight to Pearl Harbor. The morning after
    arrival I was picked up by car and driven to a warehouse and told to go
    to an office in the back and up one flight. There I was met by a Chief
    Petty Officer and a LT(jg), who I later learned was the Personnel
    Officer for PSTS. Our conversation hinged on the concept of war;
    whether the old style of breaking things and killing people or would we
    rather just take over an ill populace. I was told that ``President
    Kennedy had personally believed this and he had chosen us to carry this
    concept into working order. We were the best at our primary jobs, could
    handle very well other jobs on board a ship, and we could pass the
    security clearance factor.'' Well, when our president wanted me for
    special work, who was I to say no! Of course I accepted the challenge.
    When the 2085 was tied up and the civilian crew had left, those of us
    already in Pearl went to the boat and met our skipper and chief
    engineer. Our skipper was a full Lieutenant and the Chief Engineer was
    a senior E-6 Engineman about twice my age. All this for a small boat,
    107 feet in length and mostly black in color. (Army colors) It needs
    grey, but first we find out that we do not wear our Navy uniforms. Then
    we gather on the Granville S. Hall for a security briefing that
    informed us that we would not leave the base without an undercover
    escort, one of which we may, or may not, figure out but there would be
    someone else also covering us. We went out on shakedown cruises,
    training on seamanship, and for our job in research. Then we had
    firefighting training. We were brought as a crew into a `classroom'
    setting and trained on the exposure suits and gas masks. This part of
    the training was filmed by an Army photo unit. Then to the G.S. Hall
    for shots, something special as we were only told the basics when we
    got them. Then decontamination of the interior of the vessel using
    challengers filled with betaPropilactone and formalin. I turned them on
    and left the area, closing the hatch behind me. After the challengers
    were empty they shut down and we opened the 85 and went back to our
    home. No one told us it was safe to re-enter the boat. We still had
    liquid running down the bulkheads in most of the vessel. We had sealed
    only the refrigerator and opened the rest of the interior to assure
    there were no bugs still on board. Now on to Emergency Ship handling
    school where an E-4 (me), an E-6 (one of our cooks), and three officers
    off a submarine, a Lieutenant Commander and two LTs (jg)'s made up the
    class taught by a Commander.
        We had five LTs and six crews, we were trained for our job, but
    there was a President who had not been elected, but had assumed the
    position after the death of our beloved JFK. Volunteers were requested
    to keep one crew in Pearl and transfer the balance back to the fleet. I
    elected to stay with the unit as I had earned advancement to E-5.
    During the down time we put in electronic spares on each boat, cared
    for the vessels, and a few excursions. One was the time a Russian
    Trawler had need of spare parts only available in the port of Honolulu.
    Well, on that day, while a Geodesic Survey ship and other `proper'
    ships of the line were in the harbor, we were out with one of the LT's
    equipped to spray agent, practicing our man overboard procedures. Grey
    harbor tug manned by people in civilian clothes with the ability to lay
    down a spray--and they had the long lenses and lots of film. Were we
    out there as bait of a sort, I so believe to this day?
        Election up coming, let's get up to strength by bringing in the
    other new crews. Now we are back on our proper vessels getting ready
    again to go into research, to work. Most of the engineering crew had
    some experience with tugs but most of the ET's came from destroyers or
    large vessels. But our Weathermen came off a carrier or a shore
    installation, never anything as bouncy as a tug. The placard said
    ``This vessel not to be operated on ocean or coastwise waters, signed,
    commandant U.S. Coast Guard'' and seemed to have validity. I do know
    that one time I had a roll of 65 degrees and a pitch of 40 degrees as
    this was what was needed to throw the gyro out of kilter, and it did.
    OK, after the inauguration of LBJ we were ready to start Shady Grove.
    This was to take place near Johnston Island and we needed to transit to
    that site. We left Pearl Harbor on the 21st of January.
        After arrival in Johnston Island we again deConned the interior of
    the vessels before doing anything else. Our air group arrived, Marine
    A4's and the ground crews. The General paid a visit to each boat. Soon
    we were underway to run the initial test, and first series of trials to
    get us acquainted with the actual procedures. About a week out at sea
    then back into port for a couple days, then out to station again. The
    weatherman and I strapped the theodalite in and proceeded to do the
    wind balloons and information to control each evening, in code. Five or
    6 days at sea then a couple days in, then back out. The testing takes
    much of the night, then during the day a minimum crew operates the ship
    to the lab ship then back to station. Minimum crew was one person on
    the bridge and one person in the engine room, and I had been appointed
    to day watch. Of course, that meant that during the tests I was asleep
    in the sleeping quarters, never knowing what was leaking through the
    filters, and going into my lungs. Our filters got everything down to 1
    micron, but they were made of paper, and this was close to the ocean
    and there was actual seawater in the area. Salt water and paper made
    for paper changing its porosity, in other words, it leaked.
        My morning at sea began before sunrise as I assisted the navigator
    in shooting the stars to determine our position after the external
    decon of the vessel. As the ship was opened up for day operations most
    of the crew went to sleep and one engineer and myself brought the
    vessel to the lab ship to off load the samples and get the special
    supplies for the next nights tests. And so it went until April when we
    completed ``Shady Grove'' and I was on my way back to Montana State
    University. My field of study was Electrical Engineering and Business.
        By the end of my first quarter on campus I needed to get some work
    to keep me busy so I applied to the Electronic Research Laboratory. I
    started with the Digital Data Systems group where we would be working
    with Water Resources Research group. We developed the Snow Pack
    measuring devices that are put into the mountain areas of the west. And
    I built the prototype. After about 3 years of school, I finally earned
    a BS degree in Commerce (General Business).
        Now to work, and a large construction company looks like the place
    to put my varied experience to work. After completing the field
    training I am offered a position in the purchasing department of
    Southwest Operations of Chicago Bridge and Iron Company. Since I had
    more law courses in school I was given the pleasant chore of
    contracting our company attorney, and one of the choices available was
    Leon Jaworski and Associates. Good thing he had a number of attorneys
    on staff as he was called to Washington, D.C., to head the Watergate
    investigation. As we expand operations I am handed the steel buying and
    before long become probably the largest single consumer of steel on the
    Gulf Coast of the United States. About 1975 I was given the added
    responsibility of managing the annual audit of SW operations, and this
    is the year we go from `Over the Counter' to the New York Stock
    Exchange. About this time that I am handed one of the largest jobs I
    have ever had. Negotiating with and meeting the proposed supplier off
    and on for a few months then one morning I receive a call, then place a
    call to New York lasting about 10 minutes and I've spent over $10
    million. I also furnished most of the steel for the last greenfield
    refinery built in the U.S.
        Next was Chemtrol Corporation as the Purchasing Manager of this
    specialty insulation company. Fireproof and radiation proof insulation
    was important in the nuclear power field anywhere in the world. And we
    did it! I'm with the company only about a month when Three Mile Island
    happened, and this certainly put a crimp in our future. After less than
    a year I move to Sales Manager for an Electronics and Metrology
    Company. We handle everything from single meters to plant process
    control (Dow Freeport). We do temperature measuring of the GM first
    battery powered vehicles to clocks on the space shuttle. It is during
    this time that the first indication of possible troubles from SHAD
    arise. I'm 41 and have hypertension, but then I have a massive spasm of
    the heart muscle. The difference between a spasm and attack is a spasm
    leaves no damage to the heart muscle, even though it can kill just as
    dead. Very unusual as normal medications work only for a short time
    then fail as the pressure goes up higher than before. Soon I am again
    not getting paid so move back to Montana. The prognosis is not good.
        I finally cannot afford medical care so end up with the VA hospital
    in Miles City, still trying to nail this down. Finally a sophisticated
    test shows a probable tumor within the body so I am sent to the Salt
    Lake VA Hospital where the tumor is confirmed. I am scheduled for
    surgery, but first I needed to be switched from the normal anti-
    Hypertensive to a quick acting variety when a timing fluke reared its
    ugly head. My blood pressure went up to over 300+/300+. The nurse told
    me I wasn't supposed to be there any longer, but I made it to the
    operating room and had an adrenal tumor removed. I did not feel, per
    what I had been told upon leaving SHAD, that I could tell the medical
    people that my internal fluids might be hazardous to their health. But
    I did survive this and went on to live without blood pressure problems
    for quite some time, but now have had a mild attack which took me to a
    cardiologist some 2 weeks after the event for one stent. Skin cancer,
    prostate cancer, replaced hip, arthritis, COPD, and now osteoporosis
    and scoliosis of the lower spine for me and only some cancer in the
    family history make me wonder, was it SHAD.
        From the age of 41 I have been unable to find work of a nature to
    fit my field of study, or that would pay anywhere near the amount I had
    earned at the electronic sales job that I had then. If that salary were
    brought to the present it would be in the neighborhood of $150,000, and
    with that I could have some funds set aside for retirement, but the
    best I have done since then has been below $18,000. That's not enough
    to leave a nest egg.

                   Statement of Paralyzed Veterans of America

        Mr. Chairman and Members of the Subcommittee, on behalf of
    Paralyzed Veterans of America (PVA), we would like to thank you for the
    opportunity to submit a statement for the record regarding the proposed
    legislation. We appreciate the fact that you continue to address the
    broadest range of issues with the intention of improving benefits for
    veterans. We particularly support any focus placed on meeting the
    complex needs of the newest generation of veterans, even as we continue
    to improve services for those who have served in the past.

            H.R. 1197, THE ``PRISONER OF WAR BENEFITS ACT OF 2007''

        This legislation would repeal the requirement that a Prisoner of
    War (POW) be held captive for at least 30 days in order to receive a
    presumption of service-connection for the purposes of receiving
    benefits. This issue was first considered during the 108th Congress
    after American service personnel who were held captive in Iraq during
    the early stages of the war were released or rescued after less than 30
    days of internment. These men and women had sustained severe injuries
    as a result of combat actions and their subsequent internment. It seems
    only fair that any POW, regardless of time in captivity, be recognized
    as being eligible for service-connected benefits. PVA supports this
    provision.
        We likewise support the addition of the following diseases to the
    list of diseases presumed to be service-connected; Type II diabetes and
    osteoporosis. We have no objections to the requirements placed on the
    Secretary of VA for adding or subtracting diseases to the presumptive
    service-connection list. We would only caution that veterans and former
    POWs should be given the benefit of the doubt before any consideration
    is given to removing a disease from the list.
        The legislation also allows a survivor of a veteran to continue to
    receive dependency and indemnity compensation for the death of a
    veteran resulting from such disease on the basis of such presumption
    after a disease is removed from regulations. PVA supports this
    provision of the legislation.

      H.R. 3008, THE ``RURAL VETERANS SERVICE OUTREACH AND TRAINING ACT''

        The ``Rural Veterans Service Outreach and Training Act'' is
    intended to improve outreach activities performed by the VA. It does so
    by creating a grant program for states to help fund their rural county
    veteran service officers. A state is eligible to apply for a grant if
    it has at least one county where veterans reside, and that county does
    not have a service officer. State eligibility may also include a county
    that has a service officer working part time, or a county that has more
    that 1000 veterans residing in it and has a full-time county veterans
    service officer but can still demonstrate a need for additional
    services by a county service officer.
        The maximum grant amount available is $1,000,000 and states will be
    able to apply annually. States are required to provide a 20 percent
    match to receive the funds and states must use the funds to increase
    their outreach activities and not to supplement existing programs.
        We believe this program can demonstrate to new veterans, as well as
    veterans from past conflicts that state governments along with the
    federal government are making a real effort to ensure that they receive
    the information, services, and benefits that they have earned. PVA
    generally supports the provisions in this proposed legislation.

            H.R. 3795, ``YOU WERE THERE, YOU GET CARE ACT OF 2007''

        PVA supports H.R. 3795, the ``You Were There, You Get Care Act of
    2007.'' This legislation allows for the men and women who served in the
    1991 Persian Gulf War and conflicts since that date to be considered to
    be radiation-exposed for the purpose of service-connection as a result
    of exposure to depleted uranium. However, we believe that this
    legislation should be expanded to include veterans who served prior to
    the first Gulf War. During the eighties, U.S. Army armor units located
    in Germany and South Korea carried armor piercing shells that were made
    from depleted uranium. While servicemembers understood that there were
    hazards associated with depleted uranium, they still spent weeks at a
    time in the tanks with these shells radiating uranium. As such, these
    veterans should also be included in this category for presumptive
    service connection.

            H.R. 4274, THE ``GOLD STAR PARENTS ANNUITY ACT OF 2007''

        PVA has some serious concerns about this proposed bill. First, we
    question how this benefit would be applied in a situation where a
    veteran has a surviving spouse or dependents as well as surviving
    parents. We do not believe that this is an appropriate benefit if the
    veteran has a surviving spouse or dependents because those individuals
    already would be the designated beneficiaries for all survivor
    benefits. Payments under this bill would be nothing more than a
    secondary survivor benefit to the parents.
        While PVA always supports benefits that recognize the sacrifices
    made by our servicemembers, we believe that providing $125 per month as
    a recognition for the death of a service man or woman is a slap in the
    face at best. The value of this benefit suggests that the life of the
    man or woman who served and died honorably is worth almost nothing.
    Moreover, to create a situation where separated parents might receive a
    $62 per month reminder of their son's or daughter's service and death
    is beyond comprehension. While intentions for this legislation might be
    good, this bill will certainly create more heartache and pain rather
    than honorable recognition. With these thoughts in mind, this
    legislation should be reconsidered.

        H.R. 5155, THE ``COMBAT VETERANS DEBT ELIMINATION ACT OF 2008''

        PVA principally supports H.R. 5155, the ``Combat Veterans Debt
    Elimination Act of 2008.'' However, we have a couple of concerns with
    the proposal. First, we believe that the legislation should afford the
    same benefit to any servicemember who might have been killed while
    serving in the line of duty. We do not think that a special distinction
    should be made between a servicemember who was killed in a combat
    theater and a servicemember who was killed while serving at his or her
    home duty station. We would ask; ``What is the difference between
    having a tank roll over on the individual in Iraq or Afghanistan, or a
    tank roll over on the individual at Fort Hood, Texas?'' The benefit of
    this legislation should be afforded to any servicemember killed while
    serving this nation honorably.
        Second, we wonder why a special exception is made in this
    legislation for certain debts to be collected. As we understand the
    bill, the only debt that the VA will be permitted to collect upon a
    servicemember's death is a home loan or small business loan.

             H.R. 5448, THE ``FULL FAITH IN VETERANS ACT OF 2008''

        PVA supports H.R. 5448, the ``Full Faith in Veterans Act of 2008.''
    This legislation will help address the high number of post traumatic
    stress disorder (PTSD) cases from Operation Iraq Freedom/Operation
    Enduring Freedom (OIF/OEF) as well as veterans from previous conflicts.
    As more information becomes available from the VA's Mental Health
    Centers of Excellence and other professional sources pertaining to the
    diagnosis and treatment of PTSD, this information must be available to
    all VA health care providers.
        The latest information must also be available to the VA's Vet
    Centers. Vet Centers are often the only VA representation in rural
    areas, and most Vet Centers are the first point of contact for veterans
    in rural areas with PTSD, as well as other mental health conditions.

                                 H.R. 5454, ALS

        PVA supports H.R. 5454, a bill that provides a presumption of
    service connection for Amyotrophic Lateral Sclerosis (ALS) for any
    veterans that served during a period of war.
        Studies published in medical neurology journals indicate a higher
    level of ALS among servicemembers that served in the Gulf War than any
    other segment of the general population. Although, at this time there
    is no causal effect standard for determining presumption, more research
    should be funded by the VA for current veterans with ALS and future
    cases. We support this presumption of service connection for these
    veterans since there is currently no medical evidence to refute the
    increased incidence among veterans.

              H.R. 5709, THE ``VETERANS DISABILITY FAIRNESS ACT''

        PVA supports the provisions of H.R. 5709, the ``Veterans Disability
    Fairness Act.'' We hope that this legislation will correct the
    inconsistencies of ratings that veterans receive from different VA
    regional offices. We have heard testimony over the last couple of years
    about veterans that may receive a 70 percent rating in one location,
    and be rated 100 percent in another region. While we understand that no
    veterans' claims are the same, there is still a great deal of
    inconsistency in application of adjudication standards and regulations.
        This legislation requires the VA to conduct reviews and audits
    annually to identify and correct inaccuracies or inconsistencies in
    disability ratings and the adjudication of claims for disability
    compensation. The VA can use that information to address the
    differences that occur nationally. To minimize the variability among
    regional offices, the VA must increase training, improve rater
    qualifications, and increase the quality review system.
        In the Veterans' Disability Benefits Commission report, released in
    October 2007, the Institute of Medicine (IOM) recommended that
    educational and training programs for VBA raters and VHA examiners be
    developed, mandated, and uniformly implemented across all regional
    offices with standardized performance objectives and outcomes. These
    programs should make use of advances in adult education techniques.
    External consultants should serve as advisors to assist in the
    development and evaluation of the educational and training programs. We
    believe this legislation begins to address this recommendation, but it
    could do more.
        We look forward to working with the VA and Congress to improve the
    consistency in disability ratings for veterans throughout the system.

          H.R. 5954, PRESUMPTION OF SERVICE CONNECTION FOR PROJECT 112

        PVA supports H.R. 5954, a bill to provide veterans with a
    presumption of service connection for purpose of benefits for diseases
    associated with service in the Armed Forces and exposure to biological,
    chemical, or other toxic agents as part of Project 112.
        The Department of Defense (DoD), originally denied the occurrence
    of tests including chemical and biological agents until a government
    investigation identified these tests. Project Shipboard Hazard and
    Defense (Project SHAD) was conducted between 1962 and 1974. Of the
    20,000 veterans that may have been exposed to these chemicals, VX nerve
    gas, Sarin Nerve Gas and E.Coli, all known to be harmful chemicals,
    only 6,000 veterans have been identified. This bill will ensure that
    all veterans that may have incurred a disease as a result of exposure
    to these chemicals will receive the medical care they deserve.
        Section 2 of the bill requires the DoD to release all records that
    will allow the VA to identify the other 14,000 veterans involved in
    Project 112. It is time that the DoD finally sets the record straight
    and comes clean about all of the activities surrounding Project 112/
    SHAD.

            H.R. 5985, THE ``COMPENSATION FOR COMBAT VETERANS ACT''

        PVA fully supports H.R. 5985, the ``Compensation for Combat
    Veterans Act.'' This proposed legislation is in accordance with a
    recommendation included in The Independent Budget for FY 2009. As
    stated in The Independent Budget:

            While VA recognizes the receipt of certain medals as proof of
            combat, only a fraction of those who participate in combat
            receive a qualifying medal [qualifying medals include combat
            badges and medals received for valor]. Further, military
            personnel records do not document combat experiences except for
            those who receive certain medals. As a result, veterans who are
            injured during combat or suffer a disease resulting from a
            combat environment are forced to try to provide evidence that
            does not exist or wait a year or more while the Department of
            Defense conducts research to determine whether a veteran's unit
            engaged in combat.

        This legislation will clarify the status of veterans that have
    served in a combat zone and have suffered a disease or injury. This
    will eliminate the need to establish evidence for proof of service-
    connection. H.R. 5985, when signed into law, will save the veteran
    valuable time in developing their claim to submit to the VA when they
    seek the medical care for an injury or disease as a result of their
    combat service.
        It is important to note that this legislation would not eliminate
    or alter in any way the requirement that a veteran's claim for
    disability have an official diagnosis or that a clear connection
    between that claimed disability and military service exists. It would
    simply relieve the burden placed on veterans who served in a combat
    theater of proving that the claimed disability was combat-related. As
    it currently exists in law, service in a combat zone or theater does
    not necessarily meet the threshold that the VA has established for
    recognizing a combat veteran. This loophole needs to be changed to
    benefit the veteran and we believe this legislation will accomplish
    that task.

                H.R. 6032, PRESUMPTION OF SERVICE CONNECTION FOR
                               PARKINSON'S DISEASE

        PVA supports H.R. 6032, a bill that provides a presumption of
    service connection for Parkinson's disease for certain veterans who
    served in the Republic of Vietnam. The 109th Congress passed
    legislation that required the Secretary to designate six centers of
    excellence for Parkinson's disease research, education, and clinical
    activities. These facilities will have an arrangement with an
    accredited medical school that provides training in neurology and
    diagnosis and treatment of neurodegenerative diseases. Medical evidence
    has indicated a higher rate of Parkinson's disease among veterans that
    have served in Vietnam. With the passage of this legislation, a veteran
    that develops Parkinson's disease will be able to receive the latest
    treatment for this devastating condition.
        Mr. Chairman, we would like to thank you again for the opportunity
    to submit a statement for the record. We look forward to working with
    the Subcommittee to ensure that the best benefits are available to all
    veterans.

                            Statement of Alan Oates,
     Edinburg, VA, Member, U.S. Military Veterans with Parkinson's (USMVP)

        Dear Chairman and Committee Members,
        I am Alan Oates, a Vietnam Veteran. I have Parkinson's disease. I
    am a member of an organization called ``U.S. Military Veterans with
    Parkinson's'' (USMVP). Our organization and members haven't received
    any Federal Grant Funds nor do we have any contracts with the U.S.
    government.
        Parkinson's is a degenerative, progressive disease without a cure.
    The physical, mental and financial burden on Vietnam Veterans suffering
    with this disease and their families is devastating.
        Public Law 102-4 was passed to provide a better means to address
    Agent Orange and the health issues that Vietnam Veterans faced.
    Congress recognized the need for an agency outside of the VA to look at
    these issues. Especially since the VA's own report by Admiral Zumwalt
    stated that the VA's review Committee on Agent Orange was so biased to
    Veterans that they should be fired. The VA classified this report to
    keep it from the public.
        However due to flaws and failed implementation of Public Law 102-4,
    the system created by Congress to help these Vietnam veterans has
    failed them. It has failed the Veteran who recently emailed me,
    pleading for help as his Parkinson's had left him unable to work and
    almost homeless--. and the Veteran who at 58 years of age was left so
    helplessly immobile in bed that his wife has to cauterize him twice a
    day. Let there be no doubt that their Parkinson's is a result of their
    service to their Country in Vietnam.
        I have met with the staff of many of the Members on this Committee
    and have provided extensive documentation and justification for passing
    this bill. As in written testimony I am limited to ten pages total, I
    am only including selected exhibits.
        After extensive research we have found:

          Vietnam Veterans were exposed to a large number of toxic
    chemicals including Agent Orange and Organophosphates.
          Evidence that connects Parkinson's disease to service in
    Vietnam and to exposure to various chemicals used in military
    operations.
          The Department of Veterans Affairs and the system
    established under Public Law 102-4 to look at the disease in Vietnam
    Veterans has failed these Veterans.

            I.  Vietnam Veterans were exposed to a multitude of chemicals
            during their military service in Vietnam. Agent Orange and
            Malathion (Malaoxon) are two of those.

                    A.  Agent Orange consisted of two herbicides, 2,4-D and
                    2,4,5-T. The production of 2,4,5-T created the toxic
                    dioxin, TCDD. This is considered one of the most toxic
                    dioxins known to man.

                            1.  The Institute of Medicine in the Agent
                            Orange Review reports that the TCDD in Agent
                            Orange could be up to 1,000 times more toxic
                            than that in the same herbicide used outside of
                            military operations (farming and home use).
                            This is important as most studies using the
                            2,4,5-T herbicide are based on a less toxic
                            form than that used in Agent Orange.

            II.  Malathion is an organophosphate insecticide.
            Organophosphates were developed by Nazi Germany in the late
            1930's as a Chemical Warfare Nerve Agent. These agents impact
            the Central and Peripheral Nervous System.

                    A.  Operation Flyswatter exposed Vietnam Veterans to
                    Malathion routinely every 9 days weather permitting.
                    B.  The long storage times, high heat and exposure to
                    sunlight cause Malathion to break down into a highly
                    toxic Malaoxon.

            III.  Agent Orange and Malathion individually and in
            combination are scientifically associated to Parkinson's
            disease.

            IV.  Evidence of Association between Parkinson's disease and
            military service in Vietnam.

                    A.  Stanford University Military Deployment Study
                    Abstract (Exhibit A) found an increase of 2.6 times in
                    the risk for Parkinson's disease in veterans who
                    deployed to Vietnam compared to those who did not.

                    B.  Dr. Chris Reid provides a nexus between service in
                    Vietnam and Parkinson's.

            V.  Agent Orange Association

                    A.  In the Iowa Agriculture Health Study Update 2007
                    (Exhibit B), Dr. Kamel found that 2,4,5-T (Agent Orange
                    herbicide) was associated with an increased risk in
                    Parkinson's disease.
                    B.  In the BMC Neurology Study published March 28,
                    2008, a strong Odds Ratio was found between 2,4-D and
                    Parkinson's disease even though the association had not
                    reached a scientific significant level.
                    C.  A study showing how 2,4-D can impact the portion of
                    the brain related to dopamine productions.
                    ``Intracerebral administration of 2,4-
                    diclorophenoxyacetic acid induces behavioral and
                    neurochemical alterations in the rat brain. Bortolozzi
                    A.''
                    D.  A study showing alterations in dopamine in basal
                    ganglia by 2,4-D in neonatal exposed rats, mediated by
                    a serotonergic modulation on the dopaminergic system.
                    E.  A study shows that 2,4-D can damage the
                    cytoskeleton structure of brain cells and disrupts the
                    microtubule of neuron cells. (2,4-D Acid Disrupts the
                    Cytoskeleton and Disorganizes thee Golgi apparatus of
                    Cultured Neurons) Silvan B. Rosso April 5, 2000).
                    Another study shows that when the microtubule is
                    disrupted in a dopamine carrying cell, it causes
                    dopamine to leak from the cell and kill the dopamine
                    cells. (Jian Feng Microtubule: A Common Target for
                    Parkin and Parkinson's Disease Toxins). The loss of
                    dopamine cells causes Parkinson's disease.
                    F.  A study (2,3,7,8-Tetracholorodibenzo-p-dioxin
                    exposure disrupts granule neuron precursor maturation
                    in the developing mouse cerebellum. Collins LL.)
                    Demonstrates the ability of alter neuron cells.

            VI.  Organophosphates Malathion Evidence of Association

                    A.  The BMC Neurology Study published 28 March 2008
                    finds scientifically significant association between
                    Organophosphates (Malathion) and Parkinson's disease.
                    B.  There are numerous studies showing how
                    organophosphates are suspect in the development of
                    Parkinson's disease.

            VII. Public Law 102-4 has failed the Vietnam Veterans.

                    A.  The law failed to address the issue that were many
                    chemicals exposure and not just Agent Orange for
                    Vietnam Veterans and narrowly focused on only the
                    herbicides used in military operations.
                    B.  The Institute of Medicine (IOM) in conducting its
                    research for the Agent Orange Reviews is limited to
                    researching only the Diseases as they are associated
                    with herbicides used in Vietnam.
                    C.  The IOM charge is to look for a scientific
                    connection between a disease and the herbicides and not
                    to look for a connection between a disease and Veterans
                    service in Vietnam.
                    D.  An example of this is in the IOM AO 2006 review as
                    cited by the Department of Veterans Affairs in the
                    Federal Register on presumptiveness for Peripheral
                    Neuropathy. A study found some association with service
                    in Vietnam but not to the chemicals of interest. The
                    focus should be, is there evidence of an association
                    between the disease and the Veterans service in
                    Vietnam.
                    E.  IOM will not look at other chemicals such as
                    Organophosphates as their charge by law is limited to
                    herbicides. There are many cases where other chemical
                    exposures such as Organophosphates and solvent
                    contribute to or cause a disease.

            VIII.  The Department of Veterans Affairs (DVA) has failed to
            implement requirements of the law.

                    A.  Public Law 102-4 required the DVA to conduct
                    studies that were recommended by the IOM in the Agent
                    Orange Reviews.

                            1.  DVA failed to conduct studies recommended
                            by the IOM in the Agent Orange Reviews.

                                    a.  Since 1994 in each review IOM has
                                    stated the importance of seeing if
                                    there is an early onset of Parkinson's
                                    disease in exposed veterans.
                                    b.  The importance of studies comparing
                                    exposed to non exposed veterans.

                    B.  DVA failed to collect and review the clinical data
                    on illnesses and disease related to Agent Orange in
                    Vietnam Veterans.

                            1.  This is evident by the fact that the DVA
                            has been unable to provide even the number of
                            Vietnam War Zone Veterans they are treating for
                            Parkinson's disease. A request was made on my
                            behalf by Congressman Goodlatte on April 9 for
                            information on Vietnam Veterans with
                            Parkinson's, as of this date.

                    C.  DVA has not provided this information. DVA failed
                    to recognize that a finding of a biologic plausible
                    mechanism in the IOM Agent Orange review is a causal
                    relationship.

                            1.  Public law 102-4 required the NAS (IOM) to
                            look to see if there is evidence of a biologic
                            plausible mechanism ``or other'' causal
                            association.

                                    a.  By using the words ``or other''
                                    Congress and the law is clear that a
                                    finding of evidence of a biologic
                                    plausible mechanism is a causal
                                    association.

                            2.  The VA Appeal Board has found service
                            connection for Parkinson's disease due to
                            herbicide exposure in two cases that we have
                            found. In one of those cases the VA admits a
                            finding of Biologic Plausibility and the appeal
                            court judge rules in favor of the Veteran based
                            partly on that point.

            IX.  DVA is required by law to evaluate the evidence for and
            against presumptiveness of a disease and rule in favor of
            presumptiveness if the evidence for is equal to or greater than
            the evidence against an association. DVA must also publish its
            findings on presumptiveness in the Federal Register and give
            the scientific basis for that finding.

                    A.  In the 2006 Agent Orange Review, IOM stated, ``In
                    pursuing the question of statistical association, the
                    Committee recognized that an absolute conclusion about
                    the absence of association is unattainable. As in
                    science generally, studies of health effects associated
                    with herbicide exposure cannot demonstrate that a
                    purported effect is impossible or could never occur.
                    Any instrument of observation, even the most excellent
                    epidemiologic study, is limited in its resolving power.
                    In a strict technical sense, therefore, the Committee
                    could not prove the absence of an association between a
                    health outcome and exposure to any of the compounds of
                    interest. That contributed to the current Committee's
                    decision to re-evaluate findings on the health
                    endpoints classified in Update 2004 as having
                    ``suggestive evidence of no association.''

                        This is a dramatic change from the prior position
                    of the IOM. ``Studies of health effects associated with
                    herbicide exposure cannot demonstrate that a purported
                    effect is impossible or could never occur.'' Since a
                    negative association is not technically possible the
                    credible evidence provided by the IOM at the worst can
                    only be viewed as neutral by DVA when evaluating a
                    disease for presumptiveness.

            X.  Since a positive causal association exists, not only
            because of the biologic plausibility but because of other
            credible evidence, DVA should have already approved
            presumptiveness for Parkinson's disease.

        The system and the DVA have failed Vietnam Veterans. We bring our
    issues to the Veterans' Affairs Committee and the House of
    Representatives (The People's House) to correct and right this
    injustice. We ask that the Committee do two things:

          First, pass H.R. 6032 and give these Veterans, who on the
    average have already suffered with this service connected disease for 6
    years and individually up to 25 years, the help they so desperately
    need. They can not afford to wait any longer for the system to be fixed
    and to then address this issue.
          Second, make the necessary changes to the system to
    insure that they will correct the problems and issues we have addressed
    in this document.

        Thank you for the opportunity to provide input on this important
    issue.

                             Excerpted Figures from
                     ``Improving the Presumptive Disability
                     Decision-Making Process for Veterans''
             Committee on Evaluation of the Presumptive Disability
                      Decision-Making Process for Veterans
                     Board on Military and Veterans Health
              Jonathan M. Samet and Catherine C. Bodurow, Editors
                Institute of Medicine of the National Academies

                 FIGURE S-1--ROLES OF THE PARTICIPANTS INVOLVED
                         IN THE PRESUMPTIVE DISABILITY
                      DECISION-MAKING PROCESS FOR VETERANS

    [GRAPHIC] [TIFF OMITTED] T3058A.001

    ---------------------------------------------------------------------------
        a Stakeholders include (but are not limited to) veterans service
    organizations (VSOs), veterans, advisory groups, Federal agencies, and
    the general public; these stakeholders provide input into the
    presumptive process by communicating with Congress, VA, and independent
    organizations (e.g., the National Academies).
        b Congress has created many presumptions itself; in 1921, Congress
    also empowered the VA Secretary to create regulatory presumptions; on
    several occasions in the past, Congress has directed VA to contract
    with an independent organization (e.g., the National Academies) to
    conduct studies and then use the organization's report in its
    deliberations of granting or not granting regulatory presumptions.
        c VA can establish regulatory presumptions; VA sometimes contracts
    with the National Academies to conduct studies and uses the
    organization's report in its deliberations of granting or not granting
    regulatory presumptions.
        d The National Academies (Institute of Medicine and National
    Research Council) submit reports to VA based on requests and study
    charges from VA.
    ---------------------------------------------------------------------------

             FIGURE S-2--PROPOSED FRAMEWORK FOR FUTURE PRESUMPTIVE

                DISABILITY DECISION-MAKING PROCESS FOR VETERANS
    [GRAPHIC] [TIFF OMITTED] T3058A.006

    ---------------------------------------------------------------------------
        a Includes research for classified or secret activities, exposures,
    etc.
        b Includes veterans, veterans service organizations (VSOs), Federal
    agencies, scientists, general public, etc.
        c This committee screens stakeholders' proposals and research in
    support of evaluating evidence for presumptions and makes
    recommendations to the VA Secretary when full evidence review or
    additional research is appropriate.
        d The board conducts a two-step evidence review process (see report
    text for further detail).
        e Final presumptive disability compensation decisions are made by
    the Secretary, Department of Veterans Affairs, unless legislated by
    Congress.
    ---------------------------------------------------------------------------

                         CONGRESSIONAL RESEARCH SERVICE

        MEMORANDUM
                            October 21, 2008

        To:
                            House Committee on Veterans' Affairs,
                            Subcommittee on Disability Assistance and
    Memorial Affairs
                              Attention: Kimberly Ross

        From:
                             Sidath Viranga Panangala, Analyst in Veterans
    Policy, 7-0623

        Subject:
                             Follow-up to Question Posed at the Legislative
    Hearing on June 12, 2008

        This memorandum responds to a question posed by Chairman John Hall
    at the legislative hearing on June 12, 2008. During that hearing
    Chairman Hall asked the following question:
        Does ALS [Amyotrophic Lateral Sclerosis] manifest more than a year
    after separation or does the veteran sometimes take that long or longer
    to recognize the symptoms and come to the [Department of Veterans
    Affairs] VA?
        Studies done regarding military service and ALS are quite limited,
    and published literature does not provide a clear answer about the
    post-service timeframe over which such an association may be seen. This
    memorandum provides a brief summary of the Institute of Medicine (IOM)
    review done to examine an association between ALS and military service
    and discusses current VA policy establishing a presumption of service-
    connection for ALS.
    Introduction
        Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's
    disease, is a rapidly progressive medical condition that affects a
    person's nervous system.\1\ The Institute of Medicine (IOM) of the
    National Academy of Sciences reports that ALS causes nerve cells in the
    brain and spinal cord to degenerate. This degeneration in turn causes a
    breakdown in communication between the nervous system and the voluntary
    muscles of the body, and eventually leads to muscle paralysis.
    Moreover, muscles responsible for breathing are affected, and
    respiration fails.\2\ It affects about 20,000-30,000 people--of all
    races and ethnic backgrounds--in the United States at any given
    time.\3\ Most people who are diagnosed with the disease die from
    respiratory failure within 3 to 5 years of the onset of symptoms.\4\
    About 10 percent of patients with ALS survive for 10 or more years.\5\
    It has been reported that the rate of progression of the disease varies
    from patient to patient.\6\
    ---------------------------------------------------------------------------
        \1\ National Institute of Neurological Disorders and Stroke,
    National Institutes of Health, ``Amyotrophic Lateral Sclerosis Fact
    Sheet,'' September 9, 2008, [http://www.ninds.nih.gov/disorders/
    amyotrophiclateralsclerosis/detail_amyotrophiclateralsclerosis.htm].
        \2\ National Academy of Sciences, Institute of Medicine (IOM),
    Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific
    Literature  (2006) p. 7.
        \3\ Ibid.
        \4\ Ibid.
        \5\ National Institute of Neurological Disorders and Stroke,
    National Institutes of Health, ``Amyotrophic Lateral Sclerosis Fact
    Sheet,'' September 9, 2008, [http://www.ninds.nih.gov/disorders/
    amyotrophiclateralsclerosis/detail_amyotrophiclateralsclerosis.htm].
        \6\ National Academy of Sciences, Institute of Medicine (IOM), Gulf
    War and Health: Health Effects of Serving in the Gulf War vol 4.
    (2006), p. 153.
    ---------------------------------------------------------------------------
    Military Service and ALS
        Many returning veterans from the Persian Gulf War began reporting
    numerous health problems that they believed to be associated with their
    service in this war.\7\ Among the conditions reported were symptoms
    associated with ALS. Given this concern among veterans that there is an
    increased risk of developing ALS among those who served in the Persian
    Gulf War, the VA asked the IOM to conduct an independent assessment of
    the potential relationship between military service and the later
    development of ALS. The IOM Committee did not address, nor was it asked
    to consider, the timeframe over which ALS symptoms appeared in veterans
    who succumbed to the disease. Based on a review of the scientific
    literature, the IOM Committee concluded that ``there is limited and
    suggestive evidence of an association between military service and
    later development of ALS.'' \8\
    ---------------------------------------------------------------------------
        \7\ Ibid. p. 1.
        \8\ National Academy of Sciences, Institute of Medicine (IOM),
    Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific
    Literature (2006), p.36. According to IOM, ``limited and suggestive
    evidence'' would indicate that evidence is suggestive of an association
    between military service and ALS in humans, but the body of evidence is
    limited by the inability to rule out chance and bias, including
    confounding factors, with confidence.
    ---------------------------------------------------------------------------
    Compensation for Disabilities Associated with ALS and Military Service
        In 2001, the then VA Secretary made a policy decision to give
    special consideration to ALS disability claims by Persian Gulf War
    Veterans who served during the period August 2, 1990-July 31, 1991.
    Under this policy veterans with ALS who served during other periods
    would not receive disability compensation.\9\
    ---------------------------------------------------------------------------
        \9\ Department of Veterans Affairs, ``Presumption of Service
    Connection for Amyotrophic Lateral Sclerosis,'' 73 Federal Register
    54691, September 23, 2008.
    ---------------------------------------------------------------------------
        The VA subsequently announced in September 2008 that it would
    establish a presumption of service-connection for ALS for any veteran
    who develops the disease at any time after separation from service.\10\
    This would relieve the veteran of the burden to prove that ALS was
    caused by a specific exposure or activity that occurred during service
    in the Armed Forces. To be eligible for this presumptive service-
    connection, a veteran must have served on continuous active duty for a
    period of 90 days or more. The VA made this decision based on the
    understanding that further research is unlikely to clarify this
    association between ALS and military service, and there is sufficient
    evidence indicating a correlation between ALS and activities in
    military service that supports establishment of a presumption of
    service-connection for ALS for any veteran with that diagnosis.\11\ VA
    also noted that it could revisit this presumption if scientific and
    medical advances in the future show that ALS is not associated with
    activities during military service.\12\
    ---------------------------------------------------------------------------
        \10\ Ibid.
        \11\ Ibid.
        \12\ Ibid.

    H.R. 5954, 2nd Session of 110th Congress
        Presumptions of Service Connection for Purposes of Benefits under
    Laws Administered by Secretary of Veterans Affairs for Diseases
    associated with Service in the Armed Forces and Exposure to Biological,
    Chemical, or other Toxic Agents as part of Project 112
    Issue
        H.R. 5954, Presumption of Service Connection for Diseases
    associated with Exposure to Biological, Chemical, or other Toxic Agents
    as part of Project 112.
    Purpose
        H.R. 5954, proposes to amend subchapter 1, chapter 11, of title 38,
    United States Code, with the addition of a new section 1119 entitled
    ``Presumptions of service connection for diseases associated with
    Project 112'' that will:

          Establish a presumption of service connection for any
    disease determined by the Secretary to have resulted from an increased
    incidence of exposure to a biological, chemical, or other toxic agent
    during service or having been directly or indirectly subjected to a
    chemical or biological warfare test under Project 112.
          Require the Secretary to determine the presumptive period
    that such disease must have manifest to warrant entitlement of service
    connection.
          Establish presumption of such exposure if the veteran
    participated in a Project 112 test and defines what constitutes Project
    112 test.
          Instruct the Secretary to notify all veterans that were
    potentially exposed as the result of Project 112 not later than 180
    days after enactment of the legislation. The Department of Defense will
    be tasked to transfer the records of active duty personnel and
    reservists that were potentially exposed within 30 days after
    enactment.
          Task VA to submit a report to Congress within 1 year
    after enactment concerning Project 112. The report will accomplish the
    following: (1) Document the costs, benefits, and challenges associated
    with continuing the search for additional Project 112 participants; (2)
    provide a full accounting of all information known concerning Project
    112 participants; and (3) address other concerns regarding Project 112
    held by the VA, veterans, or veterans service organizations.

    Program Views on Proposed Legislation
    Highlights
        This proposed legislation defines presumption of exposure for a
    Project 112 partcipant, directs the Secretary to determine what
    diseases are associated with such exposure and also to determine any
    presumptive time frame, instructs VA to contact potentially exposed
    veterans, and requires that VA deliver a report to Congress concerning
    the effects of Project 112.
    Program Views
        Project SHAD, an acronym for Shipboard Hazard and Defense, was part
    of a larger effort called Project 112 which was a comprehensive program
    initiated in 1962 by the Department of Defense (DoD) to protect and
    defend against potential chemical and biological warfare threats.
    Project SHAD encompassed a series of tests by DoD to determine the
    vulnerability of U.S. warships to attacks with chemical and biological
    warfare agents, and the potential risk to American forces posed by
    these agents. Project 112 tests involved similar tests conducted on
    land rather than aboard ships. Project SHAD involved servicemembers
    from the Navy and Army and may have involved a small number of
    personnel from the Marine Corps and Air Force. Servicemembers were not
    test subjects, but rather were involved in conducting the tests.
    Animals were used in some, but not most, tests.
        DoD continues to release declassified reports about sea--and land--
    based tests of chemical and biological materials concerning Project
    112. VA is working with DoD to obtain information as to the nature and
    availability of the tests, who participated, duration and agents used.
    DOD estimates that about 6,000 veterans may have been involved in
    Project 112/SHAD. To date, DOD has provided VA with the names of
    approximately 5,000 veterans who participated in the tests. VA began,
    in May 2002, to contact veterans who participated in Project SHAD about
    medical care and benefits to which they may be entitled.
        In October 2002, VA contracted with the Institute of Medicine (IOM)
    to conduct a three-year, $3 million study of potential long-term health
    effects of tests conducted on board Navy ships in the sixties. IOM's
    report, Long-Term Health Effects of Participation in Project SHAD, was
    published in May 2007 and found no clear evidence that specific long-
    term health effects are associated with participation in Project SHAD.
        VA opposes this legislation. We have already contracted for a
    significant long-term study concerning the health effects of SHAD
    participants and received the report from the IOM. The Secretary has
    authority to contract for an additional study if it is deemed
    necessary. We do not believe that enactment of this legislation is
    warranted at this time due to the lack of credible scientific and
    medical evidence that adequately demonstrates any statistically
    significant correlation between participation in SHAD tests and the
    subsequent development of any disease.
    Costs (Mandatory and Discretionary)
    Mandatory Benefit Costs
        This bill provides disability compensation to veterans with
    diseases associated with toxic agents and disability indemnity
    compensation to survivors of such veterans. The Department of Defense
    estimates that 6,442 veterans are currently alive who were exposed to
    toxic agents through Project 112. Under this proposal, the Secretary
    would determine which diseases warrant a presumption of service
    connection for this population and publish decisions in regulations.
    The Institute of Medicine (IOM) of the National Academies released
    their report, ``Long Term Health Effects of Participation in Project
    SHAD'' on May 30, 2007. IOM could not clearly connect any conditions to
    toxic exposure in SHAD. VA therefore assumes that no conditions would
    be determined presumptive for service-connection based on involvement
    in Project 112. We are unable to provide a cost estimate for this bill
    without further support.
    Discretionary GOE Costs
        There would be no discretionary costs as this proposed legislation
    would have no significant impact on workload.
    Contacts
        For questions please contact Adrienne Foster, at 202-461-9690, C&P
    Service Budget Staff (211C) or Christina DiTucci, ORM Benefits Budget
    Division (244A), at 202-461-9928.

                                         Committee on Veterans' Affairs
             Subcommittee on Disability Assistance and Memorial Affairs
                                                        Washington, DC.
                                                          June 23, 2008
    Hon. Michael L. Dominguez
    Principle Deputy Under Secretary of Defense
    for Personnel and Readiness
    U.S. Department of Defense
    1300 Pentagon Defense
    Washington, DC 20301

    Dear Mr. Dominguez:

        In reference to our House Committee on Veterans' Affairs
    Subcommittee on Disability Assistance and Memorial Affairs Legislative
    Hearing on H.R. 1197, H.R. 3008, H.R. 3795, H.R. 4274, H.R. 5155, H.R.
    5448, H.R. 5454, H.R. 5709, H.R. 5954, H.R. 5985 and H.R. 6032 on June
    12, 2008, I would appreciate it if you could answer the enclosed
    hearing questions as soon as possible.
        In an effort to reduce printing costs, the Committee on Veterans'
    Affairs, in cooperation with the Joint Committee on Printing, is
    implementing some formatting changes for material for all Full
    Committee and subcommittee hearings. Therefore, it would be appreciated
    if you could provide your answers consecutively on letter size paper,
    single-spaced. In addition, please restate the question in its entirety
    before the answer.
        Due to the delay in receiving mail, please provide your response to
    Ms. Megan Williams by fax at (202) 225-2034. If you have any questions,
    please call (202) 225-3608.

                Sincerely,

                                                           John J. Hall
                                                               Chairman

                                     ______

                            Questions for the Record
                     The Honorable John J. Hall, Chairman,
          Subcommittee on Disability Assistance and Memorial Affairs,
                       House Veterans' Affairs Committee
                                 June 12, 2008
       Legislative Hearing on H.R. 1197, H.R. 3008, H.R. 3795, H.R. 4274,
             H.R. 5155, H.R. 5448, H.R. 5454, H.R. 5709, H.R. 5954,
                            H.R. 5985, and H.R. 6032
                                   H.R. 3795

        Question 1: Please inform the Committee whether Depleted Uranium
    (DU) is widely used by the military, for example, in anti-tank weapons,
    tank armor and ammunition rounds.

        Answer: The United States military uses DU in armor penetrating
    munitions fired by Abrams tanks, Bradley Fighting Vehicles, and several
    aircraft systems, including the A-10. Depleted uranium also provides
    defensive armor for Abrams tanks. Depleted uranium is generally limited
    to combat situations involving enemy tanks, and, therefore, is not
    currently in wide use in theater. It also has some uses in the civilian
    community, including in stabilizers in aircraft and boats.

                                   H.R. 3795

        Question 2: Does the DoD agree that Persian Gulf War veterans were
    exposed to greater amounts of DU than the average citizen?

        Answer: Most Persian Gulf War veterans had no greater exposure to
    depleted uranium (DU) than does the average U.S. citizen. The
    Department of Defense (DoD) and the Department of Veterans Affairs
    maintain DU medical management programs to assess Servicemembers and
    veterans for possible DU exposure. The Department classifies personnel
    into three possible levels of exposure, and requires DU testing for
    those personnel in the two groups at the highest risk of exposure.
    Personnel at lower risk of exposure may also undergo testing based on
    concerns of the medical care provider or the patient. Thus far, DoD has
    tested almost 2,500 personnel serving in Operation Iraqi Freedom for DU
    in their urine specimens. Of these, only 10 have been positive for DU,
    most of whom had elevated levels associated with the presence of
    embedded DU fragments. However, the remainder of the 2,500 personnel
    tested have not shown elevation of urine uranium above the expected
    background level of natural uranium.

                                   H.R. 3795

        Question 3: According to an article published by the U.S. National
    Library of Medicine and the National Institutes of Health, American
    soldiers involved in ``friendly fire'' accidents during the 1991 Gulf
    War were injured with depleted-uranium-containing fragments or possibly
    exposed to depleted uranium via other routes such as inhalation,
    ingestion, and/or wound contamination. Through urine samples, it was
    found that most of these soldiers had above-average DU concentrations
    in their bodies. Those studies only pertain to ``friendly fire''
    injuries, so these figures would likely be much higher if all veterans
    were taken into consideration. Given these facts, does the DoD think
    that there is a slight possibility that even some Gulf War Veterans
    were exposed to DU and hence may be at greater risk of developing
    cancer?

        Answer: The Department generally concurs with the conclusions of
    the National Academy of Medicine (NAM) in its analysis of depleted
    uranium (DU) exposures during the 1991 Gulf War, which to a great
    extent have been based on decades of data arising out of industrial
    exposures to natural uranium. It is important to note that neither
    occupational exposure to natural uranium nor military exposure to DU
    (which is 40 percent less radioactive than natural uranium) has been
    shown to cause cancer in humans. Much of what is known about the
    exposure to and absorption of DU is derived from the scientific
    literature on natural uranium, which the NAM discusses at great length.

        All humans are exposed daily to natural uranium through inhalation
    and ingestion, and excrete it in their urine. Servicemembers on the
    battlefield are also exposed to natural uranium. In some unusual
    situations, they may be exposed to DU. After studying the
    Servicemembers with the highest risk of exposure to DU, it has become
    clear that the presence of embedded DU fragments is the main factor
    that results in long-term DU exposure. Neither ``friendly fire''
    victims without embedded fragments, nor other individuals with lesser
    exposures, have had increased uranium in their urine that would
    indicate levels of exposure to DU that would have an adverse health
    effect.
        Those Servicemembers and veterans at greatest risk for possible
    exposure to DU are required to undergo medical evaluation by DoD or the
    Department of Veterans Affairs. Urine biomonitoring is the most
    sensitive technique for determination of excessive intake of DU,
    including inhalation and ingestion, and exposures in excess of
    occupational safety and health guidelines are readily detectable
    through elevation of urine uranium. About 80 veterans involved in
    ``friendly fire'' incidents have been extensively evaluated, some since
    1993. Despite elevations of urine uranium levels in those personnel
    with remaining embedded DU fragments, no medical conditions associated
    with uranium exposure have been detected in any of the examined
    veterans during comprehensive medical evaluations.
        Some individuals not involved in ``friendly fire'' incidents and
    without embedded DU fragments are undergoing urine screening for DU
    because of military occupations that require them to work on damaged
    tanks, or possibly subject them to other low-level exposures. The
    Department has not identified any individual in this group who has
    tested positive for DU in the urine, and significant DU exposures are
    unlikely to have occurred in the absence of DU in the urine. Based on
    the absence of associated disease occurring in individuals involved in
    ``friendly fire'' incidents, and the negative biomonitoring results
    from others possibly at risk of exposure, DoD believes that those at
    risk of developing uranium-associated disease are limited to the small
    group invited to participate in long-term medical follow-up

                                   H.R. 3795

        Question 4: Additionally, the World Health Organization lists lung
    tissue damage leading to a risk of lung cancer as a potential effect of
    inhalation of large amounts of radioactive DU, and a DU Follow-up
    Program conducted by the Baltimore Division of the VA Maryland
    Healthcare System in January of 2000 found that health effects are
    related not only to the presence of uranium, but also to the amount of
    time or duration a person is exposed. It seems that any health effects
    are due to the total amount of exposure, not just the effects of a
    single incidence. Did the DOD take into account the duration of the
    exposure and the potential effects the length of time might have on
    servicemembers?

        The Committee has been apprised of a study conducted by a Northern
    Arizona University biochemist in 2006 that reveals that uranium can
    bind to and has profound and debilitating effects on human DNA. The
    findings seem to establish that when cells are exposed to uranium, the
    uranium binds to DNA and the cells acquire mutations, triggering a
    whole slew of protein replication errors, some of which can lead to
    various cancers. Please provide a response to these findings and
    indicate whether the DoD concludes that this research may shed light on
    the possible connection between exposure to depleted uranium and Gulf
    War Syndrome?

        Answer: The Department follows with interest the results of all
    relevant literature and research on the effects of uranium or depleted
    uranium (DU) on humans and mammalian systems. These must be interpreted
    based on whether they use in vivo (live animal) or in vitro (cell
    culture) models and what the studies are designed to measure. Medical
    science has evaluated health effects of natural uranium for more than
    50 years and DU for more than 20 years. Because DU is a heavy metal
    with minimal radioactivity, it would exert a toxic effect mainly as a
    chemical hazard rather than radioactive hazard. A few industrial
    workers (not 1991 Gulf War veterans) have developed kidney disease
    after taking in large amounts of uranium, due to its chemical
    properties. However, no human cancer, including lung cancer, has been
    linked to exposure to either natural uranium or DU.

        According to the World Health Organization, because ``DU is only
    weakly radioactive, very large amounts of dust (on the order of grams)
    would have to be inhaled for the additional risk of lung cancer to be
    detectable in an exposed group.'' The Institute of Medicine concluded
    that there was suggestive evidence of no association between exposure
    to uranium and lung cancer at doses 2-10 times higher than the maximum
    dose estimated in the DU Capstone Study. The Army's DU Capstone Study
    assessed DU dust levels in scenarios in which DU munitions struck
    vehicles, and calculated the incremental cancer risks of occupants in
    those vehicles under a variety of conditions, some of which were
    extreme. One of these conditions was the length of time occupants
    remained in the vehicle. The analysis supported the view there would be
    little or no long-term impact on the health of personnel from
    inhalation of DU particulates inside tanks or other vehicles struck by
    DU munitions.
        The Department is aware of publications by Diane Stearns and
    Virginia Coryell, of Northern Arizona University, in 2005 and 2006,
    which examined survival of Chinese hamster ovary cells exposed to a
    form of DU. While the results of the study suggest possible
    genotoxicity from the chemical effects of uranium exposure in a
    mammalian tissue culture system, these results must be viewed in
    perspective. Uranium is an element that is found everywhere in our
    environment, although some parts of the Earth contain higher
    concentrations of it in the soil. On average, more than four tons of
    natural uranium exists in the top foot of soil in every square mile on
    Earth. All humans are exposed to low levels of uranium on a daily
    basis, including in food, water, and the air we breathe. Everyone has
    about 80 milligrams of naturally occurring uranium in their body as a
    result of natural exposure, and excretes uranium in the urine. Most
    substances that we encounter have adverse effects in certain situations
    or concentrations, and studies of undesirable effects from excess
    exposures must be interpreted by comparison to usual exposures, or the
    norm. However, there is no way to compare the Northern Arizona
    University results with what would constitute a normal exposure.
        Furthermore, Service members evaluated for DU exposure are measured
    against a norm of low levels of natural uranium, rather than the total
    absence of uranium. Personnel with confirmed elevations in uranium
    levels are referred to the DU program for long-term medical follow-up.
    Significant elevations in urine uranium levels are associated with the
    presence of embedded DU fragments, and represent continuing exposures.
    Even after more than 15 years of follow-up for some individuals with
    embedded fragments of DU, no health effects resulting from their DU
    exposures have been detected other than wounds caused by the DU
    fragments. In addition, no birth defects have been observed in any of
    the offspring of these veterans. From Operation Iraqi Freedom
    deployments, about 2,500 personnel at elevated risk of DU exposure have
    undergone testing, and only 10 have been confirmed positive and
    referred for continued follow-up.

                                   H.R. 5454

        Question 5: Please inform the Committee when the results of these
    research projects you mention in your Statement for the record (DAMA
    Subcommittee hearing, June 12, 2008) will be available.

        Answer: Two of the ongoing research projects will finish in 2009:

          Harvard University--``Prospective study of Amyotrophic
    Lateral Sclerosis Mortality Among World War II, Korea, and Vietnam
    veterans;'' and
          University of Cincinnati--``Biomarkers for Amyotrophic
    Lateral Sclerosis in Active Duty Military''

        Other projects should complete in 2010.

                                   H.R. 5454

        Question 6: You admit that there are a few reports that show a
    possible association between ALS and military service, but you maintain
    that this is still insufficient evidence. So what would you consider to
    be sufficient evidence that would lead the DoD to conclude that there
    is some level of causation between military service and ALS?

        Answer: The Department concurs with the conclusion of the Institute
    of Medicine (IOM). The IOM published a report on Amyotrophic Lateral
    Sclerosis (ALS) in November 2006, entitled ``Amyotrophic Lateral
    Sclerosis in Veterans: Review of the Literature.'' Based on the
    strength of the scientific evidence, the IOM concluded that there was
    ``limited and suggestive evidence of an association between military
    service and later development of ALS.'' This means the IOM concluded
    the evidence was not strong enough for causation. A causal relationship
    requires stronger scientific evidence than an association requires.

        The IOM stated that about 5-10 percent of ALS cases in the general
    population are inherited, and the causes of the remaining 90-95 percent
    of cases are not known. Similarly, in the studies of ALS in veterans,
    about 10 percent of the cases were inherited, and the causes of 90
    percent of the cases were not known. IOM pointed out that there have
    been many ALS studies in the general population that examined
    occupations, physical trauma, strenuous physical activity, and
    lifestyle factors, but there have been no consistent results.
        The IOM made a recommendation to ``conduct further corroborative or
    exploratory studies to elucidate ALS risk factors relevant to military
    service.'' There are several ongoing research studies that are
    evaluating the possible relationship between military service and later
    development of ALS. When completed, these studies will provide
    additional evidence on whether military veterans are at increased risk
    for developing ALS, compared with individuals who did not serve in the
    military.

                                   H.R. 5454

        Question 7: On June 12, 2008, there was testimony delivered during
    the DAMA Subcommittee hearing by a veteran diagnosed with ALS (Jeff
    Faull) who cited a study funded by the DoD that found that veterans of
    the 1991 Gulf War are approximately twice as likely to develop ALS as
    those not deployed to the Gulf. Would the DoD consider this as
    sufficient evidence to conclude causation between ALS and military
    service?

        Mr. Faull also referred to a study conducted at Harvard that
    concluded that veterans from other eras, ranging from before World War
    II to after Vietnam, are also twice as likely to develop ALS as those
    who have never served in the military, regardless of whether the
    service was during time of peace or war, or at home or abroad?
    Moreover, the study indicated that veterans were at greater risk of
    becoming afflicted with ALS regardless of whether they served during a
    time of war or peace, or whether they served at home or abroad. Is the
    DoD aware of this study? If not, please inform the Committee of the
    DoD's opinion on the results of the aforementioned study now that it is
    aware.

        Answer: The Department is aware of the study, ``Occurrence of
    Amyotrophic Lateral Sclerosis, Among Gulf War Veterans,'' published in
    the medical journal, Neurology, in September 2003. The Institute of
    Medicine (IOM) published a report on ALS in November 2006, entitled
    ``Amyotrophic Lateral Sclerosis in Veterans: Review of the
    Literature.'' On pages four and five of this report, the IOM states,
    ``the results of a single study are not sufficient evidence to conclude
    causation between Amyotrophic Lateral Sclerosis (ALS) and military
    service.'' The Department of Defense (DoD) concurs with IOM's
    conclusion that the results of a single study are insufficient.

        The Department is aware of the study conducted by Harvard
    University researchers, ``Prospective Study of Military Service and
    Mortality from Amyotrophic Lateral Sclerosis,'' published in Neurology
    in January 2005. The Department reviewed this study and determined that
    it used appropriate methods. In fact, DoD provided funding to the
    Harvard University researchers to perform additional research on ALS in
    veterans of World War II, Korea, and Vietnam.

                                   H.R. 5954

        Question 8: Has the DoD provided the Department of Veterans Affairs
    with all of the names of participants in the Project SHAD and Project
    112 testing?

        Answer: The Department of Defense (DoD) has provided the Department
    of Veterans Affairs (VA) with all the names of the participants in
    Project 112 and Project Ship Hazard and Defense (SHAD) that it has
    discovered to date. The Department vigorously pursues any new leads it
    receives on possible exposures in Project 112/SHAD. If during our
    investigations of these leads, we find new Project 112/SHAD exposures,
    DoD immediately notifies the VA.

                                   H.R. 5954

        Question 9: Please provide a response to the U.S. Government
    Accountability Office's claims that the DOD needs to provide a more
    objective analysis of the costs and benefits of actively searching for
    Project 112 participants and that until then your efforts are
    questionable? The Committee adds that the GAO also stated that the
    American public cannot be assured that the DoD's current effort is
    reasonable and effective until you address the following limitations:

        a.  DOD's effort lacks clear and consistent objectives, scope of
    work, and information needs that would set the parameters for its
    effort.
        b.  DOD has not provided adequate oversight to guide this effort.
        c.  DOD has not fully leveraged information obtained from previous
    research efforts that identified exposed individuals.
        d.  DOD's effort lacks transparency since it has not kept Congress
    and veterans service organizations fully informed of the progress and
    results of its effort.

        Answer: In late 1991 and continuing for approximately 5 years, the
    Department of the Army, as the Department of Defense (DoD) executive
    agent, responded to several congressional inquiries on behalf of three
    possible Project Shipboard Hazard and Defense (SHAD) veterans. In 1992,
    the Army confirmed the existence of Project SHAD and provided, in
    relation to these specific inquiries, vessels involved, test locations,
    and substances used. In 1994, the Army provided unclassified or
    redacted documents. In 1998, renewed interest in the release of
    additional information on the Project 112 test program developed. In
    August 2000, the Department of Veterans Affairs (VA) asked DoD to
    provide more information on SHAD tests. At that time, VA wanted
    information on three tests--Autumn Gold, Copper Head, and Shady Grove--
    to satisfy pending claims.

        In September 2000, DoD assigned responsibility for the
    investigation to the organization now known as Force Health Protection
    and Readiness (FHP&R). FHP&R personnel held weekly meetings with VA to
    ensure that DoD's search produced information that would be useful
    information to VA. This information included dates/location of tests,
    vessels involved, lists of agents, stimulants, tracer material, and
    decontaminants used. VA did not request agent concentration
    information. VA decided that if an illness was linked to an exposure,
    the veteran would receive compensation.
        DoD's investigation indicated that the Desert Test Center (DTC)
    planned both shipboard and land based testing. Investigators quickly
    determined that there were a significant number of tests conducted. In
    all, DTC personnel planned for 134 tests and conducted 50. DoD decided
    that veterans of individual tests should not have to wait for a full
    report of the investigation. Investigators prepared fact sheets for
    each test and delivered the names of exposed individuals to VA as soon
    as they compiled and declassified the necessary information. DoD
    provided information on Autumn Gold, Copper Head, and Shady Grove to VA
    on September 13, 2001, and simultaneously posted fact sheets relating
    to these tests on the FHP&R web site. DoD continued this procedure
    (develop fact sheets on tests, identify veterans possibly exposed, post
    the fact sheets on the FHP&R Web site, and notify VA of the individuals
    exposed on those tests) until the investigation was completed.
        In researching Project 112/SHAD, DoD investigators compiled over
    34,000 pages of relevant material. Locations searched for documents
    included West DTC, Dugway Proving Grounds, Navy Historical Center,
    Naval Surface Warfare Center, Edgewood Chemical and Biological Center,
    United States Army Chemical Center and School, Defense Technical
    Information Center, National Archives, Office of Naval Research, and
    the Office of the Secretary of Defense Historical Office. The discovery
    of DTC annual and semi-annual progress reports was a major breakthrough
    in the investigation that allowed a better understanding of the
    universe of tests planned. Many of these documents remain classified
    for national security reasons. However, without compromising national
    security, DoD investigators declassified portions of relevant documents
    and used this declassified material to build fact sheets for each test
    that accurately reflects the nature of Project 112 testing.
        During its investigation, DoD found no test specific medical
    records or classified medical records. Technical reports on tests did
    not include personally identifiable information on the health effects
    of exposures. The purpose of these tests was to assess dissemination
    characteristics and operational countermeasures, not health effects on
    personnel.
        Identification of Navy personnel was straightforward. Test
    documents identified the dates of the test and the trials associated
    with each test. Using these dates and the Enlisted/Officer Distribution
    and Verification Report (Quarterly listing of the ship's crew), ship's
    deck logs, and the ship's personnel diary, investigators identified
    personnel on-board during tests. Unfortunately, these documents are not
    available for the Navy tugs involved in several tests and complete
    information on these vessels is still lacking.
        Identifying individuals on land-based tests proved more difficult.
    DoD investigators identified military personnel who participated in
    these tests from test officers' log books, temporary duty orders,
    country clearance measures, overtime reports, letters of commendation,
    and similar documents. DoD investigators were able to identify
    personnel on only one-third of the land-based tests.
        Investigators could not totally identify three other groups of
    Project 112 personnel: the aircrews who loaded the spray tanks used on
    some SHAD tests, the pilots who flew spray missions, and members of the
    Project 112 technical staff.
        In August 2003, we provided Congress with a complete report,
    detailing our efforts to identify Project 112/SHAD testing and the
    individuals possibly exposed during this testing. Since our 2003 report
    to Congress, DoD received numerous phone calls and letters from
    veterans relating to participation in Project 112. These veterans have
    shared with us temporary duty orders, letters of commendation, etc.,
    that enabled us to identify additional Service members involved in
    Project 112. However, these individuals were not able to identify
    locations that might contain additional SHAD documents.
        Additionally, the Institute of Medicine (IOM) conducted a study of
    the ``Long-Term Health Effects of Participation in Project SHAD,''
    publishing its report in 2007. In support of this effort, DoD provided
    IOM with the Project 112 Exposure database. Using the same documents
    used by DoD, IOM reviewed the database and identified additional
    personnel possibly exposed. Working with IOM, DoD validated an
    additional 394 SHAD participants.
        The Department is currently identifying all non-Project 112/SHAD
    personnel possibly exposed to chemical and biological agents from World
    War II to the present. The DoD contractor conducting research for this
    effort completed a review of documents available at Dugway Proving
    Ground. During this review, they found no new individuals associated
    with Project 112 tests. They did find some additional tests for a few
    civilians already identified as participating in known Project 112
    tests.
        Having conducted an exhaustive search for information on Project
    112/SHAD, DoD does not concur that any degree of searching records
    archives for a long ago terminated program would result in a more
    complete documentation of all aspects of the program. The evidence
    found produces an accurate picture of Project 112/SHAD. We currently
    know of no other investigative leads that would meaningfully supplement
    that picture. We instructed the current contractor looking for non-
    Project 112/SHAD exposures to collect the names of any individuals they
    discovered exposed in Project 112. FHP&R will investigate any new
    information that may be presented and share that information with VA
    and the public.
        The DoD program and actions address the intent of the GAO
    recommendations. The GAO stated that DoD had ``agreed to and has in
    some cases begun taking action to respond to the five
    recommendations.'' The Department updated its program goals and
    objectives to identify individuals who were possibly exposed during
    chemical and biological tests outside of Project 112. The revised
    statement of work, implementation plan, and concept of operations
    ensure consistent guidance and deliverables that are responsive to the
    GAO recommendations.
        The Office of the Special Assistant for Chemical and Biological
    Defense and Chemical Demilitarization Programs oversees the current
    program and has established an implementation plan with the Deputy
    Assistant Secretary of Defense (Force Health Protection and Readiness)
    (DASD(FHP&R)) delineating program oversight responsibilities. The
    following controls are in place: monthly reporting, quarterly program
    reviews, and data reviews with key personnel from the office of the
    DASD(FHP&R). As recommended by GAO, the DoD program manager conducts
    quarterly site visits.
        Under the revised statement of work, the support contractor
    conducts research to identify other organizations performing similar
    work. During quarterly reviews, the contractor presents analyses and
    reports on those sources that it recommends should be coordinated with
    and leveraged to identify additional individuals possibly exposed. As
    noted in DoD written comments to the draft GAO report, DoD continues to
    identify Project 112 participants when new leads or information is
    shared with us or VA from any source, including former Service members
    and others knowledgeable of these tests. DoD continues to develop and
    provide guidance to individuals possibly exposed during these tests.
        The DASD(FHP&R) continually adds information to its website to
    update the public on DoD's current efforts. FHP&R is upgrading this Web
    site to include information on possible exposures outside of Project
    112/SHAD. In February 2008, representatives of the DASD(FHP&R) briefed
    the veterans and military service organizations on our efforts and the
    DASD(FHP&R) will continue to brief these organizations on a periodic
    basis.

                                   H.R. 5985

        Question 10: If this bill is not enacted, how would the DoD suggest
    making, maintaining, and transmitting military records amidst the often
    chaotic environment in which they are created in combat?

        a.  What does/would the DoD do in a situation where a
    servicemember's combat records are lost or otherwise irretrievable?

        Answer: The proposed amendment does not improve the likelihood of a
    fair hearing in these cases, because it proposes the addition of a
    provision to establish Service connection that would require
    information from official records. Lost records place an unfair burden
    on a veteran who is seeking to establish Service connection for a
    disease or injury. The Department provides assistance to reconstruct
    lost records, but this is not a guarantee that the information needed
    to prove Service connection will be recovered.

        Current law already addresses cases where official records cannot
    be used to provide Service connection. Title 38, United States Code,
    section 1154, subsection (b) clearly establishes a different burden of
    proof for the veteran and the government in cases where Service
    connection is called into question. This is evidenced by two provisions
    in the subsection:

          First, the Secretary of Veterans Affairs shall accept
    satisfactory lay or other evidence that the disease or injury was
    incurred or aggravated by service, which involved the engagement of the
    enemy in combat as sufficient proof of Service connection. If there is
    no official record that the disease or injury was incurred or
    aggravated by such service, the Secretary shall resolve every
    reasonable doubt in favor of the veteran.
          Second, the criterion for a rebuttal of a claim for
    Service connection is the presentation of clear and convincing evidence
    to the contrary.

        The legal framework for a reasonable evaluation of the evidence and
    a fair decision concerning a claim for Service connection is already
    established. The addition of a criterion to consider service in a
    combat zone to be equivalent to service, which involves engaging the
    enemy in combat, really does not address the issue of lost records.

                                   H.R. 5985

        Question 11: Given the changing dynamic of combat in the current
    OEF/OIF conflicts (where there are virtually no lines or enemies in a
    certain uniform and where there are not many ``safe areas'') please
    explain how the DoD identifies a combat area, i.e., an area where a
    servicemember would engage in combat with the enemy?

        Answer: There may be several definitions of ``an area where a
    Service member would engage in combat with the enemy,'' depending
    whether the context is operational or for other purposes. For the
    purpose of establishing eligibility for tax benefits under section 112
    of the Internal Revenue Code, the Department identifies a potential
    ``combat zone'' as an area, both land and sea, where combat operations
    are either occurring or likely to occur. Once a consensus is reached on
    the area, the Department drafts an Executive Order and recommends that
    the President sign the order, formally establishing the Combat Zone.

                                   H.R. 5985

        Question 12: Service Medals are typically presented on a unit
    basis. Please describe how the DoD defines ``engaged in combat with the
    enemy'' for the purposes of awarding service medals. How does the DoD
    award service medals to those service members who ``engaged in combat
    with the enemy'' apart from his/her assigned unit, i.e. truck drivers
    on a convoy, etc.?

        Answer: The term ``Department of Defense Service medals''
    encompasses all of the Department of Defense (DoD) Campaign,
    Expeditionary, and Service medals, including the Afghanistan Campaign
    Medal (ACM), Iraq Campaign Medal (ICM), Global War on Terrorism
    Expeditionary Medal, Global War on Terrorism Service Medal, Kosovo
    Campaign Medal, National Defense Service Medal, and many others. Many
    of these medals include criteria that authorize award based on a
    Service member being engaged in combat with the enemy. Specifically,
    the ACM and ICM criteria authorize award for being ``engaged in combat
    during an armed engagement,'' regardless of the amount of time spent in
    the area of eligibility. It is the responsibility of unit commanders,
    many of whom are on the ground in Iraq and Afghanistan, to determine if
    a Service member's specific situation constitutes actual combat during
    an armed engagement that would warrant award of the ACM or ICM. The
    Department and the Services do not define ``engaged in combat during an
    armed engagement'' for the purpose of awarding the ACM and ICM in order
    to allow as broad an interpretation as possible.

        The majority of Service members are awarded DoD Service medals, not
    for being engaged in combat, but for serving the required number of
    days in the specified area of eligibility. For those Service members
    who are authorized the award based on combat engagements, it is the
    Service member's responsibility to request award based on the ``engaged
    in combat during an armed engagement'' criteria and to notify their
    local chain-of-command of the qualifying combat engagement. The local
    commander verifies eligibility based on witness statements from other
    personnel present at the time of the combat engagement. The authority
    to authorize award of DoD Service medals has been delegated down to the
    local command level in order to expedite processing of such requests.
                                   H.R. 5985

        Question 13: On average, what is the waiting period for a deserving
    servicemember to receive a medal for military service?

        a.  Please describe the process for awarding service medals.
        b.  Are there avenues to expedite this process?

        Answer: The Department of Defense (DoD) Service medals include
    Campaign, Expeditionary, and Service medals. Examples of DoD Service
    medals include the Iraq Campaign Medal (ICM), Afghanistan Campaign
    Medal (ACM), Global War on Terrorism Expeditionary Medal, Global War on
    Terrorism Service Medal, and National Defense Service Medal, to name a
    few. Each military department is responsible for prescribing
    appropriate regulations for administrative processing and awarding of
    DoD Service medals.

        The Services do not track the waiting period for a Service member
    to receive a DoD Service medal. As one would expect, processes for
    award of Service medals vary for each Service based on its respective
    regulations and award systems. However, since determining eligibility
    is basically an administrative review to ensure eligibility criteria
    have been met, the timeframe between providing proof of eligibility and
    updating personnel records is minimal, normally less than 30 days.
    Award authority is delegated to the local commander in order to
    expedite the award process. The Department is aware of no avenue to
    further expedite this process nor is there evidence to suggest that
    there is a problem with the timely award of DoD Service medals.

                                   H.R. 6032

        Question 14: Please comment on the results of the most recent IOM
    Report on the possible health effects of Agent Orange and other
    herbicides used during the Vietnam War?

        Answer: The Institute of Medicine (IOM) report ``Veterans and Agent
    Orange Update 2006'' was released in late 2007. The update fulfills the
    mandates of the Agent Orange Act 1991 and the Veterans Education and
    Benefits Expansion Act for the National Academy of Sciences, which
    require a comprehensive evaluation of scientific and medical
    information on the health effects of exposure to Agent Orange, other
    herbicides used in Vietnam, and the chemical components of those
    herbicides.
        The Department of Veterans Affairs (VA) established an internal VA
    Work Group to formally review the report. The Department awaits the
    completion of VA's formal review. This update will assist in the
    development of VA policy related to disability determination for
    Vietnam veterans claiming injury from Agent Orange exposure.