[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]


                                  
                         [H.A.S.C. No. 118-57]

                         DEPARTMENT OF DEFENSE

                         MONITORING OF COVID-19

                               __________

                                HEARING

                               BEFORE THE

                   SUBCOMMITTEE ON MILITARY PERSONNEL

                                 OF THE

                      COMMITTEE ON ARMED SERVICES

                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               __________

                              HEARING HELD

                             MARCH 7, 2024

                                     
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                              __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
55-233                     WASHINGTON : 2024                    
          
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                 SUBCOMMITTEE ON MILITARY PERSONNEL

                      JIM BANKS, Indiana, Chairman

ELISE M. STEFANIK, New York          ANDY KIM, New Jersey
MATT GAETZ, Florida                  CHRISSY HOULAHAN, Pennsylvania
JACK BERGMAN, Michigan               VERONICA ESCOBAR, Texas
MICHAEL WALTZ, Florida               MARILYN STRICKLAND, Washington
BRAD FINSTAD, Minnesota              JILL N. TOKUDA, Hawaii
JAMES C. MOYLAN, Guam                DONALD G. DAVIS, North Carolina
MARK ALFORD, Missouri                TERRI A. SEWELL, Alabama
CORY MILLS, Florida                  STEVEN HORSFORD, Nevada

              Natalia Henriquez, Professional Staff Member
                 Ilka Regino, Professional Staff Member
                  Alexandria Evers, Research Assistant
                            
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page

              STATEMENTS PRESENTED BY MEMBERS OF CONGRESS

Banks, Hon. Jim, a Representative from Indiana, Chairman, 
  Subcommittee on Military Personnel.............................     1
Tokuda, Hon. Jill N., a Representative from Hawaii, Subcommittee 
  on Military Personnel..........................................     2

                               WITNESSES

Martinez-Lopez, Dr. Lester, Assistant Secretary of Defense for 
  Health Affairs, Office of the Secretary of Defense; accompanied 
  by Shauna Stahlman, Senior Epidemiologist, Armed Forces Health 
  Surveillance Division, Defense Health Agency, Public Health....     4

                                APPENDIX

Prepared Statements:

    Banks, Hon. Jim..............................................    21
    Martinez-Lopez, Dr. Lester, joint with Dr. Shauna Stahlman...    25
    Tokuda, Hon. Jill N..........................................    23

Documents Submitted for the Record:

    Department of Defense Report on Cardiac and Kidney Issues in 
      Service Members Prior to and Following the COVID Vaccine 
      Requirement................................................    37

Witness Responses to Questions Asked During the Hearing:

    [There were no Questions submitted during the hearing.]

Questions Submitted by Members Post Hearing:

    [There were no Questions submitted post hearing.]
    
.             
             DEPARTMENT OF DEFENSE MONITORING OF COVID-19

                              ----------                              

                  House of Representatives,
                       Committee on Armed Services,
                        Subcommittee on Military Personnel,
                           Washington, DC, Thursday, March 7, 2024.
    The subcommittee met, pursuant to call, at 2:48 p.m., in 
room 2118, Rayburn House Office Building, Hon. Jim Banks 
(chairman of the subcommittee) presiding.

  OPENING STATEMENT OF HON. JIM BANKS, A REPRESENTATIVE FROM 
     INDIANA, CHAIRMAN, SUBCOMMITTEE ON MILITARY PERSONNEL

    Mr. Banks. The hearing will now come to order.
    I ask unanimous consent that the Chair be authorized to 
declare a recess at any time. Without objection, so ordered.
    And I ask unanimous consent that members may have 5 
legislative days to revise and extend their remarks. Without 
objection, so ordered.
    I want to welcome everyone to this hearing of the Military 
Personnel Subcommittee. Today we convene to address a matter of 
paramount importance: How the Department of Defense [DOD] 
monitoring of COVID-19 has impacted our military ranks and the 
implications of the COVID-19 vaccine on the health and well-
being of our service men and women.
    Over the past 4 years the COVID-19 pandemic has presented 
unprecedented challenges to our Nation and its Armed Forces. As 
the virus has become just another part of the yearly flu 
season, we need to look with clear eyes and healthy skepticism 
at how the Department handled the pandemic, the effects of the 
virus and vaccines on our service members' health, and if the 
Department's policies and practices actually mitigated any risk 
to service members and their families.
    Many service members and their families are concerned with 
the safety and value of the COVID-19 mRNA vaccine, prompting 
questions about adverse reactions and unforeseen circumstances, 
most concerningly related to heart conditions and hypertension 
in a young military population. And the data is worrying.
    In 2022, we saw heart rate conditions like hypertension and 
cardiomyopathy among service members increase by 47 percent and 
94 percent respectively over DOD averages.
    In addressing this pandemic there is no doubt that the 
Department has made mistakes and that some decisions were made 
for political gain rather than based on science and fact.
    So today we seek clarity for the service members who took 
the COVID-19 vaccine, for their families, and for everyone's 
future health and well-being.
    We seek to understand the extent to which the Department of 
Defense has monitored the impact of COVID-19 on our military 
personnel including any potential correlation between the virus 
itself and the development of medical conditions.
    Moreover, we aim to examine the data surrounding the 
administration of the COVID-19 vaccine within our ranks, 
evaluating its safety profile and any observed trends in 
adverse reactions and health outcomes.
    As stewards of our Nation's defense, it is incumbent upon 
us to ensure the well-being of those who wear the uniform. We 
owe it to our service members to provide them with the best 
possible care and support especially in times of crisis.
    By convening this hearing, we demonstrate our commitment to 
transparency, accountability, and above all the health and 
safety of our military community.
    I would like to welcome our witnesses; Dr. Lester Martinez-
Lopez, the Assistant Secretary of Defense for Health Affairs at 
the Department of Defense, and Dr. Shauna Stahlman, senior 
epidemiologist of the Armed Forces Health Surveillance Division 
at the Defense Health Agency, Public Health.
    Thank you for being here today. I hope this hearing 
provides us an opportunity for our members to have a productive 
exchange. Before hearing from our witnesses let me offer 
Ranking Member Tokuda an opportunity to make any opening 
remarks.
    [The prepared statement of Mr. Banks can be found in the 
Appendix on 21.]

STATEMENT OF HON. JILL N. TOKUDA, A REPRESENTATIVE FROM HAWAII, 
               SUBCOMMITTEE ON MILITARY PERSONNEL

    Ms. Tokuda. Thank you, Mr. Chair. Thank you to our 
witnesses for being here today and providing testimony 
regarding the Department of Defense's health surveillance 
efforts which includes monitoring health threats and emerging 
infections, biosurveillance, and epidemiological analysis, to 
include the impacts of infections and vaccines.
    As a member of the House Select Subcommittee on the 
Coronavirus Pandemic I am not unfamiliar with efforts to 
politicize science behind vaccines to the detriment of public 
health and national security.
    I cannot emphasize enough the importance of using a fact-
driven science-based approach to this conversation today. Let's 
focus on the facts.
    Safe and effective COVID-19 vaccine options have been 
readily available since 2021. According to the CDC [Centers for 
Disease Control and Prevention], in the first 10 months that 
COVID-19 vaccines were available, they saved over 200,000 lives 
and prevented over 1.5 million hospitalizations in the United 
States.
    This is the purpose of these vaccines, to save lives and 
prevent severe illness. While the military COVID-19 vaccine 
requirement was rescinded in January 2023, 96 percent of the 
Active and Reserve force, over 1.9 million people, safely 
received one or more doses of a COVID-19 vaccine.
    Vaccine requirements have longstanding precedent in our 
Armed Forces. Since the founding of the U.S. military, vaccine 
requirements have been necessary to preserve military readiness 
and personal safety, from General George Washington's smallpox 
vaccination of the Continental Army in 1777 to the flu vaccine 
requirement in the mid-20th century.
    Today, the Department administers as many as 17 different 
vaccinations, and while it was in effect, the COVID-19 
vaccination requirement helped ensure that our Armed Forces 
remained healthy and medically ready.
    Service members that have received COVID-19 vaccines have 
done so under the most intense safety monitoring program in 
United States history. The CDC, the Food and Drug 
Administration [FDA], and other Federal partners use multiple 
passive and active surveillance systems and data sources to 
conduct comprehensive safety monitoring of COVID-19 vaccines 
and the Department of Defense conducts near real-time 
monitoring and research on the impacts of COVID-19 vaccinations 
and infections through the Military Health System.
    Studies continue to show that the benefits of COVID-19 
vaccines outweigh the risk. Yet concern and apprehension 
regarding the safety of COVID-19 vaccinations do still exist. 
This may be due in large part to a fundamental misunderstanding 
of the Department's COVID-19 vaccine surveillance data which 
has unfortunately been the subject of misleading news stories 
over the past year.
    The Department of Defense's monitoring efforts of COVID-19 
have reported a small number of increases in adverse health 
effects following the COVID-19 vaccine requirement. But 
correlation does not imply causation. Legitimate questions 
remain as to the root cause of these identified adverse health 
effects.
    The overarching question for today's panel is one of 
paramount importance: Are there long-term effects from COVID-19 
on our service members and if so, how do we discern whether any 
increase in reported adverse health effects are attributable to 
the virus itself or to the vaccine.
    To address this question comprehensively we must approach 
today's discussion with scientific rigor, ensuring that we 
prioritize the health and safety of our All-Volunteer Force as 
a whole above all else.
    As we navigate the complexities of this issue we must 
acknowledge the profound impact that the COVID-19 pandemic has 
had on the operational readiness of our Armed Forces. First and 
foremost, the pandemic resulted in thousands of 
hospitalizations across the Department and the tragic loss of 
hundreds of lives.
    It also had far-reaching second- and third-order effects on 
our military including disruptions in training exercises and 
deployments, the mobilization of military medical personnel to 
support civilian pandemic response efforts, and negative 
impacts to military family quality of life issues like delays 
in moves, child care, and health care access.
    At the heart of today's discussion regarding the 
Department's monitoring of COVID-19 lies a fundamental 
commitment to the health and well-being of our service members. 
That must ultimately include a shared dedication to 
transparency and facts grounded in scientific evidence.
    Mr. Chairman, I'd like to request that the Department of 
Defense's ``Report on Cardiac and Kidney Issues in Service 
Members Prior to and Following the COVID Vaccine Requirement'' 
be included in the record for today's hearing.
    Mr. Banks. Without objection.
    [The information referred to can be found in the Appendix 
on page 37.]
    Ms. Tokuda. Thank you, Mr. Chair.
    Congress required this report in fiscal year 2023 NDAA 
[National Defense Authorization Act] and it serves as an 
example of the careful and thoughtful monitoring the Department 
is doing.
    Thank you again, Mr. Chair, for this hearing and I look 
forward to our witness testimony and the responses to questions 
that will be posed today.
    I yield the balance of my time.
    [The prepared statement of Ms. Tokuda can be found in the 
Appendix on page 23.]
    Mr. Banks. Thank you. I understand that you have one 
consolidated opening statement. We respectfully request that 
you summarize your testimony in 5 minutes or less. Your written 
comments and statements will be made part of the hearing 
record.
    Following opening statements, each member will have an 
opportunity to question the witnesses for a very liberal 5 
minutes.
    With that, Dr. Martinez-Lopez, you may make your opening 
statement.

STATEMENT OF DR. LESTER MARTINEZ-LOPEZ, ASSISTANT SECRETARY OF 
DEFENSE FOR HEALTH AFFAIRS, OFFICE OF THE SECRETARY OF DEFENSE; 
 ACCOMPANIED BY SHAUNA STAHLMAN, SENIOR EPIDEMIOLOGIST, ARMED 
  FORCES HEALTH SURVEILLANCE DIVISION, DEFENSE HEALTH AGENCY, 
                         PUBLIC HEALTH

    Dr. Martinez-Lopez. Chairman Banks, Ranking Member Tokuda, 
distinguished members of the subcommittee, we are pleased to 
represent the Office of the Secretary of Defense to discuss the 
Department's ongoing health surveillance of the force related 
to COVID-19 in the aftermath of the global pandemic.
    This testimony provides the committee with information on 
some of the key data used to track the health of service 
members and provides updates on some past and future studies 
related to the impact of COVID-19 on the health of the service 
members.
    Service members, like all members of our Nation, 
experienced the effects of the global COVID-19 pandemic. 
However, unlike the civilian population, when service members, 
particularly those deployed or are on operational units, became 
sick with COVID-19 it impacts national security.
    This is an unacceptable risk for the military and our 
Nation. As part of force health protection, the Department of 
Defense took actions to blunt the impact of the pandemic on the 
force and to maintain operational readiness.
    This was achieved primarily through force health protection 
measures like vaccinations, testing, masking, symptom 
monitoring, and remote work.
    These actions saved lives and resulted in less severe 
disease and fewer hospitalizations among those service members 
that were infected.
    Nevertheless, the impact of COVID-19 lingers with some 
service members and veterans, just like many other Americans, 
are experiencing the long-term effect of COVID-19 infections 
including long COVID and heart-related conditions.
    As we seek to keep the total force healthy and on mission, 
the Department monitors for infectious diseases and a range of 
other health threats. We do this through a dedicated staff with 
public health commands co-located with military units around 
the world.
    In addition, we have a team of analysts evaluating the data 
for trends and investigating any signal that are identified.
    One of the primary tools these health threats analysts used 
to answer complex epidemiological questions is a relational 
database called the Defense Medical Surveillance System, or 
DMSS.
    As the central repository of medical surveillance data for 
the U.S. Armed Forces, DMSS contains up-to-date and historical 
data on diseases and medical events including inpatient and 
ambulatory medical encounters, immunizations, prescriptions, 
laboratory data, deployment health assessment, and casualty 
data.
    To enhance our ability to identify signals in the noise of 
infectious disease data we have a related capability to DMSS 
called the Defense Medical Epidemiology Database, or DMED.
    DMED, used in its proper context, is a useful tool for DOD 
medical and public health professionals to monitor health 
trends among their local populations and identify potential 
issues that require further inquiry or research.
    The DOD's data is compelling. In looking at the impact of 
vaccine, the Department's data show that unvaccinated 
individuals with a reported COVID-19 infection were at 
significantly higher risk of developing three cardiac 
conditions--myocarditis, pericarditis, and acute myocardial 
infarction--compared to individuals who received a COVID 
vaccine.
    Further, the DOD data show that among the 31 Active Duty 
service members who died from COVID-19, none of them were fully 
vaccinated.
    Now, today, 4 years after the emergence of SARS-COVID-2 
virus, it continues to circulate in our military communities 
and evolve into new variants, presenting an ongoing health 
threat capable of harming service members and affecting 
operations.
    The Department remains committed to protecting the health 
of the force and to better understand these impacts as we 
prepare for future health threats.
    Our ongoing studies will support the development of 
therapeutics and medical countermeasures. We will also continue 
to evaluate the relationship between COVID-19 infection or 
COVID-19 vaccinations and cardiac conditions through 
surveillance and research.
    Our ongoing data surveillance will help inform future DOD 
policy on force health protection, improve readiness, and help 
prepare for and mitigate against future health threats.
    Thank you for inviting us here today to speak with you 
about the Department's health data which enables our ongoing 
surveillance of the impact of the COVID-19 and the force--and 
the health of the force.
    We look forward to answering your questions.
    [The joint prepared statement of Dr. Martinez-Lopez and Dr. 
Stahlman can be found in the Appendix on page 25.]
    Mr. Banks. Thank you for your opening statement. I'll begin 
with questions and yield myself 5 minutes.
    Dr. Martinez-Lopez, I find it convenient that in the report 
to Congress you cited in your testimony, the same report that 
the minority just entered into the record, that the researchers 
chose to use 45 days as the at-risk period following a COVID-19 
infection but only 21 days for the at-risk period following the 
COVID-19 vaccination, especially when the administration and 
the--the Biden administration's CDC told everyone that you 
weren't considered immune immediately after the shot.
    Seems to me like you were skewing the data to make it fit 
what you wanted the conclusion to be by doing that and to 
justify your use of the vaccine.
    You also admitted that the sample sizes are inaccurate due 
to underreporting. So how are we to trust the Department and 
the Biden administration that you all are being honest when it 
reaches a conclusion that all of these medical problems were 
due to the infection and not the vaccine?
    Dr. Martinez-Lopez. Mr. Chairman, as a retired soldier and 
now given the opportunity to serve the safety and the health 
and the readiness of the force and the service members is most 
important to me.
    The data is very clear, you know, that you have higher risk 
of developing these conditions if you got--just got the disease 
without the vaccine. The vaccine doesn't exempt you from 
getting some of these complications but it really does decrease 
the risk to the service members.
    I will defer to Dr. Stahlman on the 45 versus the--the 
timeline differential.
    Dr. Stahlman. Sure. Thank you. As an epidemiologist with 
the DHA [Defense Health Agency], I am concerned as well with 
the health and wellness of our service members and we take 
reports of any increase in medical conditions that are 
potentially due to vaccine or to the virus seriously.
    In that report we worked with cardiologist specialists 
within DHA to determine the best risk window to use when 
looking at an adverse event in relation to the vaccine or to 
the virus.
    If you're looking at an event due to a vaccine, say, 5 
years later it becomes less likely that that event is actually 
due to the vaccine because you've accumulated much more 
exposures over time.
    So in talking with cardiologists and SMEs [subject matter 
experts] and in the work that the immunizations healthcare 
division has done in clinically following the myocarditis and 
pericarditis cases within DOD we knew that most myocarditis and 
pericarditis cases when they occurred due to result of vaccine 
will occur within 21 days after the vaccine.
    We also know in working with cardiologist experts within 
DOD that if you're going to have a myocarditis or pericarditis 
event following COVID-19 infection, it's most likely to show up 
within that 45-day period.
    So we chose that period because we're using administrative 
data. We were not able to go in to confirm that the event was 
clinically ruled out due to some other condition.
    So using administrative data you have to use a risk window 
period so that it's likely you're looking at an event that's 
due to your exposure.
    Mr. Banks. Okay. So on that point, either one of you, can 
you tell me how many new cases of myocarditis there were among 
Active Duty service members in 2020?
    Dr. Stahlman. Thank you. There are around 100 to 200 cases 
of new myocarditis among Active Component service members each 
year.
    Mr. Banks. What about 2020? Obviously, you track this.
    Dr. Stahlman. We do, but I do not have that exact number in 
front of me.
    Mr. Banks. Okay. So according to DOD data obtained by 
Senator Ron Johnson there were 275 new myocarditis cases among 
Active service members in 2021, which is a 151 percent more 
than average over the 5 years prior.
    And the reason I bring that up is because I asked your 
office before this hearing to give me that specific number and 
you gave me the 20--instead of giving me the 2020 numbers you 
gave me the 2021 numbers.
    So it's very suspicious why you wouldn't have that data 
available when you have the exact--you had an exact answer for 
me for 2021.
    Dr. Stahlman. Thank you. We do have the number. I do not 
have it in front of me.
    It takes our analysts time to write programming code to 
pull the data. It then has to be reviewed by an epidemiologist 
to ensure that the code is accurate, that the output is 
accurate, and we will get you those numbers.
    Mr. Banks. Can you at least remember if there were fewer 
cases of myocarditis in 2020 than what there were in 2021? I 
mean----
    Dr. Stahlman. I believe they were higher in 2021 than in 
2022. As the report--the duty report on cardiac and kidney 
issues shows there was more than a 10 times increased rate in 
myocarditis among Active Component service members who had a 
recent COVID-19 infection compared to a 2.6 increased rate 
among Active Component service members who had recently 
received the COVID-19 vaccine.
    Mr. Banks. I'm going to yield 5 minutes to Ms. Tokuda.
    Ms. Tokuda. Thank you, Mr. Chair.
    Just some basic questions, perhaps, so that we get a better 
understanding of the research and the data that you folks have 
been doing.
    What does DOD currently use the DMSS, the Defense Medical 
Surveillance System, and DMED, Defense Medical Epidemiological 
Database, data for?
    I'm just trying to get an understanding of the regular 
practical uses of the data beyond research.
    Dr. Martinez-Lopez. Congresswoman, we take very seriously--
I mean, data to formulate policy is critical to us, especially 
when it comes to clinical policy.
    So I'm not the expert. I will defer. But I'll open up 
saying we have two systems--we have multiple systems. The two 
key systems is the DMSS, the Defense Medical Surveillance 
System--that's a relational database that encompasses pretty 
much all the health--many of the health care points of every 
service member since--I think since 1990.,
    And then we have another system, it's called DMED, the 
Defense Medical Epidemiological Database. That's not a 
database. That's a web-based tool that actually can perform 
queries into the DMSS.
    But it's really for the field. That information is not 
identifiable for a particular patient. So it's that it gives 
you--gives the people in the field an idea that something may 
be happening and that's what we want.
    But then if you have a question about something happening 
then we have to do further studies using the other system, the 
DMSS. But I'll defer to Dr. Stahlman if she wants to expand.
    Dr. Stahlman. Yes. Thank you.
    DMED is used more as hypothesis generating. It allows users 
to do certain limited canned queries of the data. The default 
output--if you do a query on DMED looking at a certain ICD 
[International Classification of Diseases] diagnostic code from 
a drop-down list that you can choose, the default output that 
it will give you are--include numbers of outpatient encounters 
with diagnoses made in the first diagnostic position.
    So it's a useful tool to get a quick idea of how common 
we're seeing--how commonly we're seeing encounters for certain 
conditions. It can also do very basic population-level queries. 
It does not contain any information about vaccine.
    The Defense Medical Surveillance System is used by health 
analysts at the Armed Forces Health Surveillance Division to do 
comprehensive health surveillance for service members.
    It's the data source that feeds the DMED. So DMED is 
refreshed on a approximately monthly basis with data from the 
DMSS but just a limited amount of those data.
    Ms. Tokuda. Thank you. That differentiation is very 
helpful. You know, I think part of it is while DMED seems to be 
more of that open source that you have it is also very--it's 
very limited and if people do not understand that in fact it is 
an aggregated--it's an aggregated data set--it's not 
disaggregated, you know, obviously, because you have privacy 
issues, although you could potentially deidentify some of that.
    But because it is not disaggregated out you really can't 
differentiate between new encounters, followup encounters. I 
believe that's something that you've referenced in your 
testimony, that this DMED is very much limited, potentially 
open to misinterpretation of results for those that are using 
it to--you know, in the field to try to figure out if something 
is happening.
    So my question would be given that it's subject to 
misinterpretation and it's very limited in its scope because it 
is aggregated, has there been conversations about perhaps 
making DMED more of a disaggregated type of system so that you 
can get truer results if you're actually using it?
    I mean, if not it's always going to be subject to potential 
misinterpretation by the users or limited by user understanding 
of the data that's within it.
    Dr. Martinez-Lopez. Congresswoman, I think the intent of 
the DMED is to have it available across the force as the first 
trigger. In other words, you have a question, you have a 
query----
    Ms. Tokuda. I guess my concern is you have it as a first 
trigger. But if the user is unsophisticated to understand that 
it's limited, what you're going to have out there is 
misinformation and false assumptions.
    So I do feel that we have to make sure when we do have 
these data sets that it gives the most accurate information 
possible and is as user friendly as possible.
    I think right now the way DMED is, you know, it is great 
that it's there but I think it is going to be subject to more 
misinformation and false assumptions being made if users are 
unaware of its limitations and misinterpreting the data that 
they're getting from it.
    I know, Chair, I'm almost out of my time so I will just 
yield back to you.
    Mr. Banks. Thank you. I yield 5 minutes to Mr. Gaetz.
    Mr. Gaetz. Dr. Martinez-Lopez, is the Department of Defense 
covering up vaccine injuries?
    Dr. Martinez-Lopez. Congressman, no.
    Mr. Gaetz. So, who is Lieutenant Ted Macie?
    Dr. Martinez-Lopez. Congressman, I don't know the 
lieutenant.
    Mr. Gaetz. Well, it's sort of the reason we're here.
    On November 27th, 2023, Navy Medical Corps Officer 
Lieutenant Ted Macie shared a video on ``X'' where he expressed 
grave concern for his patients suffering after receiving the 
COVID-19 vaccine and according to Lieutenant Macie he tried 
reporting the DOD data from the DMED system to his superiors 
and he was subsequently silenced and punished.
    He lost access to the DMED system, he's been removed from 
seeing his patients, and has been relegated to some broom 
closet somewhere to continue his service.
    It seems to me that Lieutenant Macie has suffered more than 
the people who screwed up the DMED system. So why is this 
person being punished for trying to showcase data that was 
alarming?
    Dr. Martinez-Lopez. Congressman, I'm not prepared to talk 
about specifics of the lieutenant because I really don't know. 
But I'll be glad to entertain--answer any questions regarding 
the system or the vaccines and our findings.
    Mr. Gaetz. But part of the system and the vaccines and how 
we conduct oversight is that if there are whistleblowers who 
say that you're not doing your job right and if there are 
whistleblowers concerned about a coverup, you have to--there's 
a process by which that has to get to the inspector general and 
be reviewed.
    And in the case of Lieutenant Macie's concerns, those 
languished for, like, more than 5 months. Do you have any 
reason why a request made through the chain of command to view 
this data that could illuminate concerns over vaccine injuries 
was smothered?
    Dr. Martinez-Lopez. Again, Congressman, I'm not prepared to 
talk details on the lieutenant, I'll have to defer to the Navy.
    Mr. Gaetz. Okay. Maybe let's get to what you're prepared to 
talk about. Let's get to the actual data that's so concerning 
since the people who raise concerns about the data they get 
punished and we don't seem to remember them.
    The hypertensive diseases up 23 percent when you compare 
the 2016 to 2020 averages to cases in 2021. Does that sound 
right?
    Dr. Martinez-Lopez. That sounds right.
    Mr. Gaetz. Okay. So hypertensive diseases up 23 percent. 
Then ovarian dysfunction up 35 percent. Does that sound right?
    Dr. Martinez-Lopez. I'm not specific--can we----
    Mr. Gaetz. Does that sound right, Dr. Stahlman?
    Dr. Stahlman. I think you're referencing something from an 
older document but it could be.
    Mr. Gaetz. I'm referencing data from the Defense Medical 
Surveillance System. Is that a system that you're both familiar 
with?
    Dr. Stahlman. Yes.
    Mr. Gaetz. Okay. So that system says that hypertensive 
diseases up 23 percent; ovarian dysfunction up 35 percent; 
pulmonary embolisms, which as we all know can kill you, up 43 
percent; myocarditis, as Chairman Banks was describing, up 151 
percent.
    Is it really your testimony that these massive spikes in 
these serious ailments are a consequence of contracting COVID? 
Is that your best medical opinion?
    Dr. Martinez-Lopez. Congressman, not all but, I mean, many 
of them, obviously ovarian dysfunction, there are other 
reasons; emboli, there's other reasons. But yes, there is a 
correlation not only from our data--for the data of CDC that, 
yes, correlate COVID to having higher likelihood of having some 
of these events.
    Mr. Gaetz. Pardon me for not treating the CDC's 
assessment----
    Dr. Martinez-Lopez. Not the ovarian one but the other----
    Mr. Gaetz. The vaccine or the virus?
    Dr. Martinez-Lopez. Both. The virus, [inaudible] like the 
cardiomyopathy, is a little bit higher. The risk is much higher 
if you just get the disease but you have an enhanced risk. Not 
as big as when you get the infection but you do get some risk 
from getting the vaccine. It's minimal but yes.
    Mr. Gaetz. So there is vaccine risk associated with 
hypertensive diseases, right?
    Dr. Martinez-Lopez. Hypertension--help me out [looking at 
Dr. Stahlman]. Not that I'm aware of but----
    Mr. Gaetz. Okay. Well, how about ovarian dysfunction?
    Dr. Martinez-Lopez. Not that I'm aware of.
    Mr. Gaetz. And how about pulmonary embolisms?
    Dr. Martinez-Lopez. Yes.
    Mr. Gaetz. Okay. So you're here giving us testimony that 
the vaccine increases someone's risk of pulmonary----
    Dr. Martinez-Lopez. No; pulmonary emboli, the COVID virus 
does increase----
    Mr. Gaetz. No, I'm asking about the vaccine.
    Dr. Martinez-Lopez. No. The vaccine, no. Not that I know 
of.
    Mr. Gaetz. No. And myocarditis you think there is a risk?
    Dr. Martinez-Lopez. Yes. A slightly higher risk, but it's 
much higher that--when you get the virus itself, when you get 
infected.
    Mr. Gaetz. And to tease out those data distinctions, 
wouldn't it be responsible to assess these conditions in people 
who got the disease and were unvaccinated versus the people who 
got the disease and were vaccinated? Has that type of an 
analysis been done?
    Dr. Stahlman. We did look at this in the DOD report on 
cardiac and kidney conditions. The information stratified by 
all the different ways--vaccinated, not vaccinated--those are 
not all included in the report. I do have the data on that.
    When we reported the 10 times increased rate due to recent 
infection, that is adjusting for vaccination status; it's also 
adjusting for demographic risk factors including age, sex, and 
BMI [body mass index].
    Mr. Gaetz. Right. So did that analyze ovarian dysfunction?
    Dr. Stahlman. It did not.
    Mr. Gaetz. Did it analyze pulmonary embolisms?
    Dr. Stahlman. It did not.
    Mr. Gaetz. And did it analyze hypertensive diseases?
    Dr. Stahlman. It did not.
    Mr. Gaetz. Well, I mean, we got thousands more people than 
the average in 2021 getting hypertensive diseases, thousands 
more people getting ovarian dysfunction, thousands more 
people--or, I'm sorry, hundreds more people getting these 
pulmonary embolisms.
    What's the case against analyzing those conditions that 
have seen these increases in the vaccinated versus the 
unvaccinated?
    Dr. Stahlman. We are continuing to do surveillance on these 
conditions and we are open to doing additional work on this. 
With chronic conditions it is tricky to look at that in 
relation to a vaccine.
    Mr. Gaetz. Is a pulmonary embolism a chronic condition or 
is it an acute condition?
    Dr. Stahlman. We can look at acute conditions.
    Mr. Gaetz. Yeah. Well, you know, your medical knowledge 
goes far beyond mine but I would consider a pulmonary embolism 
acute, not chronic.
    Dr. Stahlman. With hypertension it could be difficult to 
get causal evidence to link that to the vaccine. But yes, we 
can look at acute [inaudible].
    Mr. Gaetz. Right. But, see, that's what--that's how you get 
the causal evidence. The reason there are people concerned that 
the DOD is engaging in a coverup here is because you seem to be 
willfully and purposefully ignorant to those comparisons on 
these ailments that are skyrocketing now for pregnant women, 
for people who get pulmonary embolisms, for people with 
hypertension.
    And the one area you've looked, myocarditis, you're here 
giving testimony that that actually causes this increased risk 
factor.
    And so, Mr. Chairman, I hope we continue to follow up on 
this because my deep concern is that there is a coverup here 
and that they're playing games with the data so that we can't 
actually assess whether it's the vaccine or the ailment that is 
causing these acute conditions.
    And, I mean, wouldn't it be a tragic thing to have to 
discover that we hurt people with the vaccine more so than the 
virus did with the ailment, particularly in a condition where 
now the CDC, whose opinion I guess we treat like the gospel, is 
saying that you--oh, you just should quarantine for 24 hours 
after you're done with your fever.
    So they have evolving sensibilities on this and the only 
way we get to the bottom of it is that data comparison.
    I thank the Chair's indulgence, and I yield back.
    Mr. Banks. Thank you. I agree. That's why we asked for the 
2020 figures and I didn't ask you on the record before but will 
you please--will you submit the 2020 figures to the committee? 
Can we take that for the record?
    Dr. Martinez-Lopez. Yes, sir.
    [The information referred to was not available at the time 
of printing.]
    Mr. Banks. Okay. Mr. Moylan.
    Mr. Moylan. Thank you, Mr. Chairman.
    Dr. Martinez-Lopez, and by the way, thank you for your 
service in the military. I appreciate that. Our Guard unit back 
in Guam--Air and Army were also very responsive to the COVID-19 
situation.
    They played a big role in supporting our island, and our 
Adjutant General he has a lot of medical background, too. He's 
a surgeon--he's a surgeon as well. He's really concerned now we 
need to be ready for the next public health emergency on Guam. 
After all, we're INDOPACOM [U.S. Indo-Pacific Command] region. 
We're the most western territory. We need to protect our 
community and our troops.
    So what I need to know is your interest in the INDOPACOM 
area specifically on Guam to support our National Guard and Air 
Force out there because they need to be properly staffed.
    I need to know your interest in that and making sure their 
training is up to date and equipped as well so we can have--
we'll be ready for the next pandemic health emergency.
    Dr. Martinez-Lopez. Congressman, we are--actually I am 
intimately involved with the issues of Guam. I'm very concerned 
about that. My concern is that we have the systems not only for 
Reserve or Guard, for the many Active Duty that we have in Guam 
and family members.
    We are concerned about biosurveillance, making sure it's 
not just about COVID, not only about the things we know but the 
things that we may not know coming about and we want to make 
sure that, A, we detect them early and, number two, we have a 
response mechanism to ameliorate whatever threat comes in one 
way or any other way.
    Mr. Moylan. I appreciate your concern and your continuous 
interest in the INDOPACOM, specifically Guam. Thank you for 
that.
    Another question, Doctor. What do you and Admiral Valdes 
need to safeguard the Defense Health Agency's ability to 
support the military readiness if we were to enter a conflict 
in Indo-Pacific while ensuring patients do not experience a 
lapse in care?
    What steps are you taking with stakeholders, doctors, 
hospitals on Guam to prepare for future conflicts? We're way 
out there. We have no support from the mainland. Time is of the 
essence, please.
    Dr. Martinez-Lopez. Congressman, Lieutenant General 
Crosland just came from the theater, went to visit Guam and 
visited with many of the civilian and military leadership on 
the island to address the medical--she's the director of the 
Defense Health Agency and she came back with a report, you 
know, trying to understand. She understood what the issues are.
    Now we're working through how are we going to counter 
whatever gaps she found on her trip. This has to be a two-way 
conversation with not only the military leadership, it has to 
be with the civilian leadership of the island medical--in the 
medical aspects.
    So we make sure that at least that we do our best to be in 
a good position to respond to any needs that in particular our 
service members and family members need.
    Mr. Moylan. Very good. And final question, Doctor. 
Currently the U.S. Army Reserve on Guam carries out innovative 
readiness training mission in one of the villages, Yigo, to 
provide medical care to my community.
    Efforts like this are important for building goodwill 
between the people of Guam and the military, especially as the 
Department plans to station increasing numbers of personnel on 
island. What can be done to expand efforts like this? This is 
very good for our community as well.
    Dr. Martinez-Lopez. Congressman, it's in our interest to--
A, to, you know, have our troops ready and prepared to do the 
care they're going to be asked to do in combat.
    The way we achieve that is by seeing patients and taking 
care of patients. If there is an opportunity--you know, a 
mutual opportunity that by providing care to the local 
communities we also enhance our skill sets as clinicians. 
That's a win-win for the Department and our neighbors.
    So we are pursuing this not only in Guam. We're pursuing 
this across the country in those places where we can have a 
mutually agreeable and acceptable benefit. Then we're going to 
exactly go in that direction and I hope there will be many 
opportunities in Guam just to do that.
    Mr. Moylan. I appreciate that and I look forward to working 
with you closely on how we can assist as well. So thank you for 
your efforts.
    Thank you, Mr. Chairman.
    Mr. Banks. Mr. Mills.
    Mr. Mills. Thank you, Mr. Chairman.
    I appreciate you both being here, although I must say there 
is a growing trend within the DOD that my colleagues recognize 
as well where people come here unprepared to be able to have 
the substantiated data that we require and that we have 
requested to make sure that we're able to get the answers and 
follow up.
    This is not the first time. So I hope that in future 
hearings you'll actually make sure that we have the subsequent 
data that we're trying to ask for and all the algorithms and 
all the other data planning has actually gone forth.
    I want to start out with the fact that--you know, kind of 
following along one of my colleagues Mr. Gaetz's testimony 
where he talks about how many people have been impacted 
negatively, whether it be by myocarditis, whether it be by 
ovarian issues, whatever the case may be, in addition to those 
who were unconstitutionally purged out of our military for 
religious and medical freedoms that they should have been 
afforded.
    So I just want to say for the record, do either one of you 
have an opinion--an objective opinion on whether or not you 
feel that medical and religious freedoms should be a key 
element for all members of our Armed Forces?
    Dr. Martinez-Lopez. Congressman, DOD is committed to 
protect religious liberties. As you know, there's a process to 
request----
    Mr. Mills. Actually, I do know that process, by the way, 
and I got to say, if it was actually to be true, would be 
impressive, because on average they were able to adjudicate 
through six individual layers, per the Under Secretary of 
Readiness, who was here, in less than 5 minutes.
    Imagine the ability to reach out to a minister, to a 
priest, to other religious figures who they actually are trying 
to get this counsel from or looking at their independent 
medical, you know, background from historical medical data from 
their families and being able to determine that in 5 minutes.
    I can tell you, as a person who now works for the Federal 
Government, we are not that efficient. If anything, it would 
take us about 5 weeks to be able to do so. But they were 
adjudicating these in less than 5 minutes.
    Do you think that they could adequately adjudicate a 
medical or religious exemption within 5 minutes or less?
    Dr. Martinez-Lopez. Congressman, I will have to defer to 
the services that exercise--that executed that for us.
    Mr. Mills. You know, there has been an admission to the 
significant errors in the Defense Medical Epidemiology Database 
that distorted the true numbers of medical encounters faced by 
service members.
    How can you be certain this issue has been satisfactorily 
rectified as to not continue to mislead the American public?
    Dr. Stahlman. Thank you. I can take that.
    We do take data accuracy seriously. We know that data goes 
into making decisions about health care that's provided to 
service members.
    When we became aware of the programming error that was done 
in DMED--this was in January 2022--the error, by the way, was 
an analyst had used a count function instead of a sum function 
which led to the data that existed between 2016 and 2020 to be 
corrupted.
    That error was immediately corrected. Since then we have 
implemented both additional technical and functional controls. 
So on the technical side they're doing additional QC [quality 
control] steps. We have also implemented a functional team 
that's doing additional quality assurance checks on a periodic 
basis.
    Mr. Mills. So this is for both of you and I'd really like 
to hear your thoughts on this. Uniformed service members were 
expelled from the military and punished for standing up for 
their personal rights.
    How do we ensure that they are properly compensated for 
rightfully expressing these rights? How do we address the 
discrimination and mental drain that these individuals have 
faced and continue to face by things such as giving them a 
general discharge as opposed to honorable?
    Also, the DOD forcing individuals to pay back their bonuses 
where they did not separate from the military at their free 
will--they were forced out of the military.
    What would be your recommendations on how we would 
adequately compensate these individuals unconstitutionally 
purged--by the way, almost 9,000 who was unconstitutionally 
purged, in addition to the 41,000 recruitment deficits? Pretty 
significant for the largest volunteer force in the world.
    Dr. Martinez-Lopez. Congressman, as you probably know all 
those service members had the right to appeal their discharge 
to the services.
    Mr. Mills. Dr. Martinez-Lopez, we have seen where many of 
them had tried to appeal this and in many cases wasn't actually 
given any answer whatsoever.
    Again, we can adjudicate things in 5 minutes whenever we're 
denying people their medical and freedom--religious rights--but 
we can't actually adjudicate something quickly where it should 
be a simple thing that if you did not exit the service for 
something which was disciplinary and reasoning--not medical and 
religious freedom but disciplinary and [UCMJ] [Uniform Code of 
Military Justice] Article 15 or above--court martialing--then I 
don't understand how we can't at least acknowledge the fact 
that this is unconstitutionally purged and at least give them 
the opportunity on an honorable discharge as opposed to a 
general where in many cases this plagues them and follows on in 
their careers and in future jobs.
    But that still doesn't answer the bottom question, which is 
that these individuals in my personal opinion--I know there's 
others on this committee that feel the same way--should be 
compensated.
    They should have their benefits restored. They should have 
their original rank reinstated for those who actually still 
want to serve our country, not a political agenda that is 
placed before us, and they should be given the rights that they 
were actually denied.
    Would you not at least admit to the fact that these people 
who are trying to serve as you have served and as I have served 
should be denied these rights or be given these rights?
    Dr. Martinez-Lopez. Congressman, you know, we have 
processes in--and there are laws and processes in the system. I 
hope that the services will--you know, I'm confident the 
services are doing their best to exercise those procedures to 
look at each case in particular. I will have to defer to the 
services.
    Mr. Mills. Dr. Martinez-Lopez, I appreciate that you have 
the confidence. I wish that I had that and shared that same 
confidence levels. But under the, you know, direction of 
someone like Secretary Lloyd Austin I have very little when you 
talk about the dereliction of duty that has been placed forth 
and the prioritization of things that are not to the military 
Armed Forces' benefits.
    With that, I yield back.
    Mr. Banks. Thank you. I want to thank Mr. Gaetz, who just 
left the room, for requesting this hearing. I think it's a 
really important conversation, the type of oversight that this 
committee should be doing more of.
    It's important that we work together to differentiate 
between the rise of medical conditions due to COVID-19, the 
infection, or the COVID-19 vaccination.
    This effort is vital for guiding public health responses, 
informing treatment and management strategies, monitoring 
vaccine safety and maintaining the public trust in immunization 
programs.
    By systematically investigating and addressing these 
concerns, policymakers and health care professionals can 
effectively safeguard public health and the health of our men 
and women in uniform who put their lives on the line for this 
great country.
    I want to thank both of our witnesses again and thank you 
for providing your testimony and answering our questions this 
afternoon. I want to thank the members who participated.
    There being no further business, the subcommittee stands 
adjourned.
    [Whereupon, at 3:34 p.m., the subcommittee was adjourned.]
      
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