Gulf War Illnesses: Understanding of Health Effects From Depleted Uranium
Evolving but Safety Training Needed (Letter Report, 03/29/2000,
GAO/NSIAD-00-70).

Pursuant to a congressional request, GAO provided information on the
possible connection between depleted uranium exposure and Gulf War
illnesses, focusing on: (1) the scientific understanding about health
effects from exposure to depleted uranium; (2) whether the Gulf War
veterans are experiencing administrative problems with the medical
screening program for depleted uranium health effects; and (3) the
extent to which the services have implemented programs to train
servicemembers to safely operate in a depleted uranium-contaminated
battlefield.

GAO noted that: (1) the scientific understanding of depleted uranium's
effect on health is still evolving; (2) because depleted uranium is a
low-level radioactive heavy metal, the potential for health effects can
come from radiation or chemical toxicity; (3) two recent studies cited
the kidney as the organ that would show the first adverse health
effects, noting animal studies show that very high doses of uranium may
cause kidney failure; (4) however, both reviews observed that studies of
uranium miners and mill worker have not shown increased kidney disease
even though they were occupationally exposed to elevated levels of
natural uranium; (5) the Department of Veterans Affairs (VA) is
evaluating 51 Gulf War veterans considered to have the highest exposure
to depleted uranium; (6) evaluations in 1997 of 29 of these veterans,
many of whom have embedded fragments, indicate that, to date, none of
these veterans show any evidence of adverse kidney effects associated
with exposure to depleted uranium; (7) most depleted uranium-exposed
veterans with embedded fragments continue to have elevated uranium
levels in urine, which were related to lowered performance on
computerized tests assessing problem-solving efficiency and to high
levels of the prolactin hormone associated with reproductive health; (8)
the clinical significance and long-term health consequences of these
findings are undetermined; (9) some Gulf War veterans experienced
problems in fully participating in the medical screening program
established to ensure that veterans with higher than normal uranium
levels are identified for appropriate monitoring and treatment; (10) the
problems encountered by 19 of the 128 veterans interviewed included not
being contacted by the Department of Defense (DOD) or VA to arrange an
appointment at a medical facility, not receiving the required urine test
designed to detect elevated uranium levels, and not being able to
understand the test results; (11) DOD and VA subsequently corrected or
planned to correct each administrative problem GAO identified; (12) the
military services have developed depleted uranium safety training, which
instructs servicemembers on how to identify and safely deal with
depleted uranium contamination; (13) the services have begun efforts to
provide general awareness depleted uranium training to servicemembers on
a more widespread basis; and (14) however, GAO's review showed that the
required training was not being provided to all troops for various
reasons.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  NSIAD-00-70
     TITLE:  Gulf War Illnesses: Understanding of Health Effects From
	     Depleted Uranium Evolving but Safety Training Needed
      DATE:  03/29/2000
   SUBJECT:  Ground warfare
	     Military land vehicles
	     Radiation exposure hazards
	     Munitions
	     Radiation safety
	     Veterans
	     Medical examinations
	     Safety standards
	     Uranium
	     Military training
IDENTIFIER:  Gulf War Syndrome
	     Persian Gulf War
	     DOD Comprehensive Clinical Evaluation Program
	     VA Persian Gulf War Health Registry
	     Bradley Fighting Vehicle

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GAO/NSIAD-00-70

Appendix I: Scope and Methodology

24

Appendix II: Military Services' Depleted Uranium Safety Training

29

Appendix III: Army's Implementation of Common Task Test--Depleted Uranium
Training Requirement

32

Appendix IV: Comments From the Department of Defense

33

Appendix V: Comments From the Department of Veterans Affairs

35

Appendix VI: GAO Contacts and Staff Acknowledgments

36

Table 1: Number and Percentage of Unit Personnel Completing
Army's Required Common Task Test-Depleted Uranium for
Fiscal Year 1999 for Selected Army Units 32

Figure 1: 120-mm Armor Piercing Round With DU Penetrator 6

DOD Department of Defense

DU depleted uranium

VA Department of Veterans Affairs

National Security and
International Affairs Division

B-284646

March 29, 2000

The Honorable Lane Evans
Ranking Democratic Member
Committee on Veterans Affairs
House of Representatives

The Honorable Russell D. Feingold
United States Senate

The Honorable Bob Filner
House of Representatives

The Persian Gulf War marked the first battlefield use of armor-piercing
munitions and reinforced tank armor that incorporated depleted uranium,
which improved the ability of U.S. munitions to penetrate the target and of
U.S. armor to protect against enemy munitions. Depleted uranium is a
low-level radioactive heavy metal, and concerns have surfaced about whether
exposure to it could be a cause of the illnesses that many servicemembers
have experienced since the Gulf War. Moreover, because the United States
used depleted uranium munitions in Kosovo and several other countries have
or are developing depleted uranium munitions, concerns exist about potential
health effects from its use in current and future engagements.

In view of the controversy about a possible connection between depleted
uranium exposure and Gulf War illnesses, you asked us to address the
following objectives:

ï¿½ What is the scientific understanding about health effects from exposure to
depleted uranium?

ï¿½ Are Gulf War veterans experiencing administrative problems with the
current medical screening program for depleted uranium health effects?

ï¿½ To what extent have the services implemented programs to train
servicemembers to safely operate in a depleted uranium-contaminated
battlefield?

As part of our review, we conducted a telephone survey of Gulf War veterans
believed by the Department of Defense (DOD) to have received the highest
depleted uranium exposures, and who had been notified by the Office of the
Special Assistant for Gulf War Illnesses about participating in the current
medical screening program for depleted uranium. This program is operated by
DOD and the Department of Veterans Affairs (VA). We attempted to survey 194
veterans who had been notified about participation, and reached 128 veterans
(66%) to discuss their experiences with the program. We also reviewed the
services' depleted uranium training programs and the training records for
selected Army units at Fort Bragg, North Carolina, and Fort Knox, Kentucky.
Appendix I describes the scope and methodology for this report in more
detail.

The scientific understanding of depleted uranium's effect on health is still
evolving. Because depleted uranium is a low-level radioactive heavy metal,
the potential for health effects are twofold: effects from radiation and
effects from chemical toxicity. Two recent expert reviews have concluded
that current evidence suggests that it is unlikely that inhaled or ingested
depleted uranium poses a radiation health hazard, namely cancer. In
assessing health effects associated with chemical toxicity, both reviews
cited the kidney as the organ that would show the first adverse health
effects, and they noted that animal studies show that very high doses of
uranium may cause kidney failure. However, both reviews observed that
studies of uranium miners and mill workers have not shown increased kidney
disease even though they were occupationally exposed to elevated levels of
natural uranium. The Department of Veterans Affairs is currently evaluating
51 Gulf War veterans who are considered to have had the highest exposure to
depleted uranium. Evaluations in 1997 of 29 of these veterans, many of whom
have embedded fragments, indicate that, to date, none of these veterans show
any evidence of adverse kidney effects associated with exposure to depleted
uranium. However, most depleted uranium-exposed veterans with embedded
fragments continue to have elevated uranium levels in urine, which were
related, in some cases, to lowered performance on computerized tests
assessing problem-solving efficiency1 and to high levels of the prolactin
hormone associated with reproductive health. The clinical significance and
long-term health consequences of these findings are undetermined. Additional
research is underway to more fully understand depleted uranium health
effects and to better estimate the amount of depleted uranium exposure
received by Gulf War veterans.

Some Gulf War veterans experienced problems in fully participating in the
medical screening program established to ensure that veterans with higher
than normal uranium levels are identified for appropriate monitoring and
treatment. More specifically, the problems encountered by 19 (14.8%) of the
128 veterans we interviewed included not being contacted by the Department
of Defense or the Department of Veterans Affairs to arrange an appointment
at a medical facility, not receiving the required urine test designed to
detect elevated uranium levels, and not being able to understand the test
results. The Departments of Defense and Veterans Affairs subsequently
corrected or planned to correct each administrative problem we identified.

The military services have developed depleted uranium safety training, which
instructs servicemembers on how to identify and safely deal with depleted
uranium contamination. The services have integrated the depleted uranium
safety training into training courses for personnel in military occupations,
such as Army tank gunners, where the exposure potential to depleted uranium
is highest. In addition, the services have begun efforts to provide general
awareness depleted uranium training to servicemembers on a more widespread
basis, regardless of their military occupation. However, our review of
general awareness depleted uranium training at 17 Army units, while not
projectable to the Army as a whole, showed that the required training was
not provided to all troops for various reasons, such as training materials
not being available or servicemembers being away from their unit during the
training. Furthermore, because neither the Army nor Marine Corps monitor
depleted uranium training for deployments, they were unable to tell us
whether troops who recently deployed to Kosovo, where depleted uranium
munitions were used, had received depleted uranium training.

We are recommending that the Secretary of Defense ensure, by appropriate
monitoring and periodic review of training records, that all servicemembers,
including those deployed to Kosovo, receive required depleted uranium safety
training.

Depleted uranium (DU), a low-level radioactive heavy metal, is a by-product
of the process used to enrich uranium. The United States uses DU in several
of its armor-piercing munitions because its extreme density and its ability
to penetrate targets make it an effective weapon; these same properties also
enhance the protection of U.S. tanks when DU is incorporated into tank
armor. Several other countries--including the United Kingdom, Russia,
Turkey, Saudi Arabia, Pakistan, Thailand, Israel, and France--are also
reportedly developing or already possess weapon systems incorporating DU. A
cross-section of a common armor piercing munition incorporating DU is
displayed in figure 1.

Figure 1: 120-mm Armor Piercing Round With DU Penetrator
Source: U.S. Army.

When a DU munition penetrates a hard target, it breaks into fragments and
fine particles that ignite easily, and it produces uranium dust particles
that can be inhaled or ingested. During the Persian Gulf War, several
situations occurred in which potentially hundreds of U.S. servicemembers
could have been exposed to DU. These included incidents in which U.S. tanks
mistakenly fired DU armor-piercing munitions into other U.S. combat
vehicles. These friendly fire incidents exposed 102 surviving servicemembers
who were in or on the affected vehicles at the time they were struck to
embedded DU fragments and/or inhalation and ingestion of DU particles as
well as wound contamination. About 60 servicemembers who went into these
vehicles to evacuate and rescue servicemembers may also have been exposed to
DU by inhalation and ingestion. After the combat operations, about 191 other
servicemembers may have been exposed, by inhalation and ingestion, when they
entered DU-contaminated vehicles to remove unexploded munitions and to work
in or on damaged or destroyed vehicles as they were prepared for repair or
disposal. Personnel may also have been exposed to DU, by inhalation, during
and following a fire at Camp Doha, Kuwait, in which DU munitions detonated
and burned. Other personnel may have been exposed to DU as they passed
through and inhaled smoke from burning DU, handled spent DU munitions, or
entered DU-contaminated vehicles on the battlefield or in salvage yards.
More recently, U.S. aircraft used DU munitions in Kosovo; troops currently
deployed there may be exposed to DU particles as part of their peacekeeping
operations.

Following their service in the Persian Gulf War, many veterans experienced
health problems such as fatigue, muscle and joint pain, gastrointestinal
complaints, headaches, memory loss, and sleep disturbances. The causes of
these illnesses have been the source of much controversy over the past
8 years. In November 1996, the Deputy Secretary of Defense established the
Office of the Special Assistant for Gulf War Illnesses to ensure, among
other things, that DOD does everything possible to understand and explain
illnesses in Gulf War veterans. The Office of the Special Assistant has
completed several investigations, with several still ongoing, into possible
causes for the illnesses, including possible exposure to DU, chemical or
biological agents, oil well fires, and pesticides.

On August 4, 1998, the Office of the Special Assistant issued its interim
environmental exposure report on DU.2 The Office of the Special Assistant's
methodology for its investigation of DU as a potential cause of Gulf War
illnesses included (1) identifying who was exposed to DU and how, (2)
identifying the known medical effects of human exposure to DU, (3)
identifying how much DU personnel were exposed to, and (4) assessing the
health risks of the DU exposures. As part of this investigation, RAND, under
contract with DOD, conducted a review of medical and scientific literature
on DU's known medical and health effects. The scope of RAND's review covered
literature published or accepted for publication in peer-reviewed journals,
books, government publications, and conference proceedings. Also, the U.S.
Army Center for Health Promotion and Preventive Medicine estimated the
amount of DU that may have been taken into the body for personnel in, on, or
near vehicles at the time they were struck by DU munitions.

In 1993, the DU Follow-up Program was established at the Baltimore Veterans
Affairs Medical Center because of concerns about the possibility of
long-term health effects from embedded DU fragments in servicemembers
injured during Gulf War friendly fire incidents. In 1993 and 1994, the
program evaluated the health of 33 Gulf War veterans who were known to have
been exposed to aerosolized DU and, in about half the cases, who obtained
embedded fragments during friendly fire incidents and may have received some
of the highest doses. Twenty-nine of the originally evaluated 33 veterans
were reevaluated between March and June 1997. The program, which is still
underway, collected information on medical, social, family, reproductive,
and occupational exposure histories. In addition, participating veterans
received physical examinations and neuropsychological, radiological,
reproductive, and kidney function tests during 3-day hospital stays.

In July 1998, DOD and VA established an expanded medical screening program
to evaluate servicemembers potentially exposed to DU. Although the screening
program is available for any Gulf War veteran, the Office of the Special
Assistant attempted to notify and offer the screening to Gulf War veterans
who were likely to have experienced the highest DU exposures, which included
those who were in or on vehicles that were struck by DU munitions and those
who worked around DU-contaminated vehicles. The program includes a urine
test designed to identify elevated uranium levels, a DU-exposure
questionnaire, and a medical examination. Thirty servicemembers, who had
been involved in the friendly fire incidents, were identified through this
new expanded screening program and accepted invitations to participate in
the Baltimore VA Depleted Uranium Follow-up Program, which seeks to include
all servicemembers involved in friendly fire incidents. The program
evaluated these 30 new participants and 21 of the original participants
between March and July 1999.

Because DU is a low-level radioactive heavy metal, DOD believes that
servicemembers' exposures to it should be kept as low as reasonably
achievable. Consequently, in 1993 DOD required the Army to provide training
on how to identify and safely operate in a DU-contaminated environment and
required the other services to assess their DU training needs as well.

Reviews of the scientific literature conducted by RAND and the Agency for
Toxic Substances and Disease Registry (an agency within the Department of
Health and Human Services) concluded that current evidence suggests that
radiation from inhaled or ingested depleted uranium is an unlikely health
hazard. RAND also concluded that the occurrence of radiation-related effects
(such as cancer) from embedded depleted uranium fragments would depend on
the size of the fragment and its proximity to vital organs.

Both reviews observed that the kidney is the organ that shows the first
effects from depleted uranium's chemical toxicity as a heavy metal. Although
laboratory tests on animals indicate adverse kidney effects at high doses,
epidemiological studies of humans occupationally exposed to uranium have not
found an increase in kidney disease. Similarly, a VA study of 29 Gulf War
veterans believed to have been exposed to the highest levels of depleted
uranium has found, to date, no evidence of adverse effects on the kidney,
but it has found that most DU-exposed veterans with embedded fragments
continue to excrete elevated levels of urinary uranium. These elevated
levels were related, in some cases, to "subtle perturbations" in the
reproductive and central nervous systems.3 The clinical significance and
long-term health consequences of these findings are undetermined. Additional
research is underway to more fully understand DU's health effects and to
better estimate the amount of depleted uranium exposure received by Gulf War
veterans.

Analyses of DU Health Effects

Both RAND and the Agency for Toxic Substances and Disease Registry have
recently reviewed the scientific literature on possible health effects from
uranium.4 RAND found that little published scientific information exists on
the health effects of depleted uranium, but a wide body of relevant
literature exists on natural and enriched uranium. Studies of the latter
forms of uranium are considered relevant to depleted uranium health effects
because DU is less radioactive than natural or enriched uranium, and it is
identical to them in chemical toxicity. RAND and the Agency reviews examined
the literature in regard to both radiation and chemical toxicity health
effects.

Regarding radiation health effects, some types of cancer have been
associated with radiation exposure in humans. Both RAND and Agency reviews
found that no human cancer attributable to radiation from natural uranium is
documented in the literature. Since natural uranium is more radioactive than
DU, these results indicate that DU represents an even lesser risk of causing
cancer. According to the Agency, radiation from inhaled uranium is
associated with a low risk of cancer, with the main risk occurring with
co-inhalation of other toxic and/or carcinogenic agents, such as radon.
Similarly, RAND reported that no peer-reviewed published reports show
detectable increases of cancer or other negative health effects from
radiation exposure to inhaled or ingested natural uranium even at levels far
exceeding those likely in the Gulf War. RAND concluded that it would be
virtually impossible to obtain enough inhaled or ingested depleted uranium
to present a significant internal exposure. For embedded depleted uranium
fragments, RAND concluded that radiation-related effects depend on the size
of the fragment and its proximity to vital organs.

Regarding DU's chemical toxicity, RAND and the Agency cited the kidney as
the organ that would show the first adverse health effects from DU. Both
indicated that animal studies have shown that uranium can cause changes in
kidney function and at very high doses result in kidney failure. The Agency
reported that the kidney effects observed in animals can also occur in
humans if the uranium dose is high enough. However, both reviews reported
that epidemiological studies of uranium miners and mill workers
occupationally exposed to elevated concentrations of natural uranium have
shown no increased kidney disease. Moreover, the Agency reported that the
available data on uranium compounds are sufficient to conclude that uranium
has a low order of chemical toxicity in humans in view of the high exposures
to which humans and animals in studies were exposed without adverse effects
in many cases.

Both RAND and the Agency also reported that there are few studies addressing
the human reproductive effects of uranium. The Agency reported that uranium
may have adverse effects on fetal development because animal studies have
observed reproductive effects from ingestion of uranium. However, RAND
reported that the concentrations of uranium used to elicit the effects
observed in the animal studies were much greater than the highest exposure
that would occur in military or industrial settings. RAND concluded "to the
extent that reproductive health issues related to uranium have been
investigated to date, there have not been findings that would suggest a
relationship between levels of exposures that could have occurred in the
Persian Gulf and those that are associated with adverse outcomes in animal
experiments."

Based on their reviews of the scientific literature, both RAND and the
Agency outlined additional research efforts that could more fully assess the
health effects of DU. The Agency suggested several areas for further
research, including the health effects on reproductive functioning. RAND
also suggested additional research, including long-term epidemiological
studies on Gulf War veterans and continuation of the Baltimore VA Depleted
Uranium Follow-up Program.

Even though most of the DU-exposed veterans with embedded fragments in the
Baltimore VA Depleted Uranium Follow-up Program are continuing to excrete
elevated levels of urinary uranium, to date the data show no evidence of
adverse effects on the kidney--the organ presumed to show the first effects
from exposure to DU.5 Program clinical investigators also found uranium in
the semen of some, but not all, program participants. The clinical
investigators found a relationship between elevated urinary uranium levels
and high levels of the prolactin hormone associated with reproductive
health--many of the prolactin hormone levels were within the upper bounds of
the normal range. The clinical investigators also noted, however, that as of
January 2000, about 20 infants fathered by DU-exposed participants display
no observable birth defects. Finally, the clinical investigators found a
statistical relationship between elevated uranium levels and lowered
performance on computerized tests assessing problem-solving efficiency. The
clinical investigators urged caution about drawing conclusions about these
test results because of the small number of veterans with elevated uranium
levels in the study group; also, it appeared that a few veterans with
complex histories may have contributed appreciably to the observed variance.
The program director told us that the clinical significance of these
findings is currently unknown; however, the director described these "subtle
perturbations" as not normal.

Studies are underway that include analyses of the health effects from
exposure to DU. The National Academy of Science's Institute of Medicine,
under contract with VA, is conducting a review of the scientific literature
regarding adverse health effects associated with various Gulf War exposures.
This review will assess whether exposures, or combinations of different
types of exposures, are associated with illnesses experienced by Gulf War
veterans. The first phase of the review focuses on health effects to several
exposures, including DU, nerve agents, vaccines, and pyridostigmine bromide.
The review is scheduled for completion in August 2000.6

In response to the complaints of many servicemembers who returned from the
Gulf War with health problems they believed were associated with their
deployment, DOD and VA established two programs to monitor their
health--DOD's Comprehensive Clinical Evaluation Program in 1994 and the VA's
Persian Gulf Registry in 1992. Both programs include databases that contain
health and potential exposure information on servicemembers who had received
clinical evaluations as a part of the program. DOD and VA are currently
engaged in a joint study to analyze the health conditions and possible
hazard exposures in the combined databases which, as of December 1999,
included information for over 100,000 U.S. Gulf War veterans. This study
will examine the relationship between health effects and possible exposure
to a variety of hazards, including pesticides, insect repellants, oil well
fire smoke, anthrax vaccinations, and DU. The results of this study are
expected to be published by December 2000.

The Armed Forces Radiobiology Research Institute is also conducting a series
of animal studies to assess the health effects of embedded DU pellets. The
studies are examining the redistribution and toxicity of DU fragments, the
carcinogenic potential of DU, and the effect of DU on reproduction and fetal
development. According to an Institute official, these studies are expected
to be completed within 2 to 3 years. The Lovelace Respiratory Research
Institute is also conducting an animal study examining the carcinogenic
potential of embedded DU pellets as well as various cellular, biophysical,
and biochemical effects. This study is expected to be completed in April
2000.

Vehicles When Struck by DU Munitions

DOD estimates describing the extent of DU inhalation exposure of about 162
servicemembers who were in or on vehicles when they were struck by DU
munitions in friendly fire incidents and for those entering the vehicles
immediately after impact in the Gulf War are unreliable because of
questionable assumptions used in the analysis. Reliable DU exposure
estimates are important for assessing the potential for adverse health
effects from exposure to DU and will augment the medical outcome data
available from the clinical monitoring of servicemembers involved in the
friendly fire incidents.

In August 1998, the U.S. Army Center for Health Promotion and Preventive
Medicine issued its interim DU exposure assessment for servicemembers who
were in or on vehicles when they were struck by DU munitions in friendly
fire incidents and for those entering the vehicles immediately after impact.
It is believed that these individuals received the highest exposures to DU
during the Gulf War. We reviewed the methodology used by the Center in
preparing its estimates and found that it had relied extensively on a single
test conducted in 1987, which involved DU munitions striking an Abrams M1A1
tank equipped with DU armor. 7 We found that the conditions present during
the 1987 test and those present during the Gulf War for the friendly fire
incidents differed significantly, which could result in higher or lower dose
estimates than the Center's 1998 dose assessment. For example, the 1987 test
measured the DU dose resulting from less than a minute of exposure, while
the 1998 assessment assumes that servicemembers were exposed in the vehicles
for 15 minutes during the Gulf War. Similarly, the 1987 test results may
have underestimated the amount of DU exposure because the test assumed a
less intense breathing rate than believed to be experienced by Gulf War
veterans. While these differences suggest that the 1998 assessment on Gulf
War veterans' DU exposure level may be understated, other differences
suggest that they could be overstated. For example, in the 1987 test DU
munitions penetrated the DU armor of a tank, which may produce more
aerosolized DU than would be the case had it struck a non-DU armor portion
of the vehicle. In the Gulf War, DU munitions did not penetrate DU armor.
Also, in the Gulf War many friendly fire incidents involved Bradley Fighting
vehicles, which are not DU armored and therefore should not have produced
levels as high as in the 1987 test.

In response to our and congressional concerns about the accuracy of the
Center's dose estimates,8 the Special Assistant for Gulf War Illnesses (who
also serves as the Under Secretary of the Army) in October 1999 directed
that the Army conduct further testing as soon as possible. The new test will
be designed to develop more reliable estimates on how much DU servicemembers
were exposed to during the Gulf War and to provide as much information as
possible on the implications of similar exposures in future engagements.
According to an Army official, the new live-fire test design and plan are
currently being developed, and they will make extensive use of subject area
experts in designing, conducting, and reporting the test results. Army
officials estimate that it will take about
17 months to complete and interpret the results of the new tests.

The Center is also developing exposure estimates for those Gulf War veterans
who experienced lower-level exposures to DU. The Special Assistant for Gulf
War Illnesses noted that these estimates are not based on the same test data
used in developing the exposure estimates for those individuals in or on the
vehicles involved in the friendly fire incidents and, therefore, are not
subject to scientific disagreement. The Center's preliminary exposure
estimates for other lower-level exposure categories were not available for
our review as of December 1999, but were being reviewed within DOD.

Program for Some Veterans

To ensure that those Gulf War veterans with higher than normal uranium
levels are identified for appropriate monitoring and treatment, DOD and VA
established an expanded medical screening program in 1998. Our survey of 128
servicemembers found that 109 veterans we interviewed did not experience
administrative problems, but 19 (14.8%) veterans did experience problems
(such as in arranging an appointment at a DOD or VA hospital) that hindered
their full participation.

Although the medical screening program is available to any Gulf War veteran,
the Office of the Special Assistant directly contacted only those veterans
suspected of receiving the highest levels of exposure to DU. These included
veterans (1) who were in or on U.S. vehicles when they were struck by DU
munitions in friendly fire incidents, (2) who entered these vehicles to
perform rescue operations, or (3) whose duties required them to make
numerous trips into DU-contaminated vehicles. The process of identifying
veterans in these groups has continued since the program started in July
1998. As of August 1999, when we began our survey, the Office of the Special
Assistant had contacted 210 veterans who they believed were exposed to the
highest levels of DU and asked them to participate in the screening program.

We attempted to interview 194 of the 210 veterans who had been contacted by
the Office of the Special Assistant to ask them about their experiences with
the program.9 We were able to interview 128 (66%) of the 194 veterans. Sixty
(47%) of those we contacted were participating in the program. Six (10%) of
these veterans had experienced problems related to the 24-hour urine test;
more specifically, three had not been given the required 24-hour urine test,
and three had difficulty in interpreting the urine test results.10

We asked the 55 veterans who said that they were not participating but
planned to at a later time about their reasons for not yet participating. We
found that 13 (23.6%) were not participating because they were waiting for
an appointment--6 at DOD medical facilities and 7 at VA medical centers.
When these veterans were notified by the Office of the Special Assistant
about the screening program and indicated their desire to participate, they
were told that someone would call them to arrange an appointment. However,
no one had contacted them about an appointment. Nine of these 13 veterans
had been waiting at least 11 months for an appointment. The administrative
problems found in our survey occurred because DOD and VA did not adequately
monitor the status of individuals who had indicated a desire to participate
in the program to ensure all phases of the screening were complete. We
discussed the problems we identified with DOD and VA officials, who either
corrected or developed plans to correct them.

Thirteen veterans who were notified for participation were not participating
and had no plans to do so. When we asked these veterans for their reasons
for not participating, none claimed that administrative problems deterred
them. In addition, they did not claim that DOD had not informed them of
their possible exposure, and they did not cite a lack of trust in DOD or VA
as a reason for not participating. Many of the veterans reported more than
one reason for not participating. The most frequently cited reasons are as
follows:

ï¿½ Their health had not been affected from exposure to DU (11 respondents).

ï¿½ They did not believe that they were exposed to DU (7 respondents).

ï¿½ Job demands or a lack of money or time had prevented them from
participating (7 respondents).

The lack of DU training and delays in providing it have been long-standing
issues for the services. In January 1993, we reported that the Army had not
effectively educated its Gulf War personnel about the hazards of DU
contamination and proper safety measures, and we recommended that the
services provide appropriate training to those servicemembers who may be
exposed to DU.11 In June 1993, the Deputy Secretary of Defense directed the
Army to ensure that DU training was provided to servicemembers and required
the other services to also assess their DU training needs. In April 1998,
the Special Assistant for Gulf War Illnesses reported that the services had
not made sufficient progress in implementing DU training and that
servicemembers were only marginally better prepared to contend with DU
hazards than they had been during the Gulf War.

To review the status of DU training provided by the services, we visited
each of the service headquarters and several Army schools where DU training
is conducted. We found that each service provides DU training for military
occupations considered to have the greatest likelihood for DU exposure, such
as Army chemical unit personnel, Army tank gunners who would fire DU rounds
in combat, Navy personnel who operate the Phalanx weapons system (which also
fires DU rounds), and Air Force explosive ordnance disposal personnel. Since
the beginning of fiscal year 1995, DU training modules have been included in
21 military skill specialty and noncommissioned officer and officer
leadership courses taught to over 26,000 personnel. Each service has also
provided DU training to medical personnel who are responsible for treating
troops who may be wounded by DU munitions.

Beginning in 1998, the services initiated efforts to provide DU training to
the general population of troops on a more widespread basis, regardless of
their military occupations, either as part of basic training, unit readiness
training, or predeployment training for personnel subject to duty in areas
where they may encounter DU. The services vary in their approaches to
providing this general awareness DU training. For example,

ï¿½ the Air Force requires general awareness DU training for all personnel
subject to mobilization and deployment and as part of basic training;

ï¿½ the Navy targets its general awareness training to specific types of
shipboard personnel it believes most likely to encounter DU in a conflict,
such as corpsmen, damage control personnel, and ammunition handlers;

ï¿½ the Marine Corps plans to make DU general awareness training a requirement
for enlisted personnel in all units during fiscal year 2000 and to include
DU training in several officer-level courses; and

ï¿½ the Army incorporated DU tasks into the required unit level common task
test12 for 5 consecutive years (fiscal years 1999 through 2003).

Appendix II provides more detailed information on the numerous training
modes each service has taken or plans to take to implement DU training.

To determine if soldiers are receiving the required DU awareness training,
we reviewed training records at selected Army sites. We chose the Army for
our review because, as the service with the largest numbers of ground
troops, it is the service with the greatest likelihood of having large
numbers of troops exposed to DU on the battlefield. Also, the Army formally
required the general awareness DU training and stressed the importance of
common task training as its mechanism for providing it. The Army, however,
does not centrally track the extent to which servicemembers are provided the
required common task test training components; that information is kept at
the individual unit level. Because no central records were available, we
selected several Army units to test the implementation of DU general
awareness training.

We reviewed fiscal year 1999 common task training and testing records at 16
Army units at Fort Bragg, North Carolina, and 1 unit at Fort Knox, Kentucky.
The review, which included over 1,600 personnel, indicated that only 65
percent received the required DU training. We also found a great deal of
disparity among units in that three units had not conducted the required DU
training at all, while four units had provided the training to almost
everyone (over 90%) in the unit. Appendix III shows in more detail the
results of our review.

Reasons given for not providing the required DU training to all units and
personnel included the following:

ï¿½ Another common task was substituted for the DU task because the unit did
not have the DU training materials available or lacked the expertise to
conduct the training.

ï¿½ Scheduled DU training was superseded by a larger scale training deployment
requirement.

ï¿½ Common task training and testing was interrupted by a hurricane.

ï¿½ Some individuals were on leave, sick, or away at other training during the
conduct of common task training.

All the above reasons for not providing DU training to unit personnel could
have been overcome or avoided if the common task training had been scheduled
early in the year so that (1) needed equipment could have been obtained, (2)
the training could have been rescheduled if other priorities or conflicts
arose, and (3) personnel away from the unit at the time of the training
could have been trained when they transferred into or returned to the unit.

Because DOD and the services do not monitor DU training for deployments,
Army and Marine Corps officials in Washington, D.C., and Europe were unable
to tell us whether Army and Marine Corps troops who recently deployed to
Kosovo had received DU training prior to or during the deployment. This lack
of information is potentially significant because our forces in Kosovo used
DU munitions. Army officials said that since DU is a common task training
item, the units in Kosovo should have received the training at some time
during fiscal year 1999, but they could not confirm that the training had
occurred. Marine Corps officials said that the Marine Corps had no policy or
directive to provide DU training to deploying troops and would do so only if
directed by the responsible commander in chief.

We believe that the Under Secretary of the Army acted appropriately in
directing the Army to conduct new live-fire DU tests. Proper analyses of the
test results should provide more reliable estimates of the level of DU
exposure experienced by servicemembers who were in or on the vehicles
involved in friendly fire incidents during the Gulf War or who may be
exposed to DU in future engagements. Because of the Army's apparent
commitment on this issue, we are not making any recommendations but we plan
to monitor the Army's conduct of this testing.

U.S. servicemembers continue to use DU munitions and may be exposed to them
from other sources as a growing number of other countries incorporate DU
into their weapon systems. Because depleted uranium is a low-level
radioactive heavy metal, servicemembers' exposure to it should be kept as
low as reasonably achievable. The services, therefore, need to do more to
ensure that servicemembers receive safety training on how to properly
operate in a DU-contaminated battlefield. Proper implementation of the
training programs is essential to achieving a necessary level of protection.
While our review of training records was limited to the Army, the importance
of training implementation is applicable to the other services because they
also employ DU in their combat systems and could encounter damage from enemy
DU munitions. Given that DU munitions were used in Kosovo and U.S.
servicemembers are deployed to the region, we believe that it is especially
important to know whether they have received DU safety training.

To provide that both active and reserve component servicemembers receive
depleted uranium safety training, we recommend that the Secretary of Defense

ï¿½ direct the secretary of each military department to ensure, by appropriate
monitoring and periodic reviews of training records, that active and reserve
component servicemembers receive required annual or biennial depleted
uranium safety training and

ï¿½ identify whether servicemembers currently deployed to Kosovo have received
depleted uranium safety training, and if not, provide it promptly.

In commenting on a draft of this report, DOD concurred with our
recommendations that the Secretary of Defense ensure that all
servicemembers, including those deployed to Kosovo, receive required
depleted uranium safety training. DOD further described actions it has
already taken to emphasize the importance of this training.

DOD also stated that we accurately reported the findings from two recently
published reviews of medical literature related to depleted uranium health
effects. DOD took exception, however, to our presentation of the Baltimore
Depleted Uranium Follow-up Program findings in the Results in Brief. DOD
stated that we did not include key caveats related to those veterans with
embedded fragments, a small number of veterans with complex histories, and
the clinical significance of the findings. We revised the Results in Brief
to more completely reflect these caveats.

In follow-up to VA's written comments, the VA's Chief Officer, Public Health
and Environmental Hazards, Veterans Health Administration, agreed with the
findings and conclusions in the draft report and stated that they have taken
action to correct the problems that we identified during our audit work.

DOD and VA comments are presented in their entirety in appendixes IV and V,
respectively. DOD and VA also provided oral and technical comments, which we
have incorporated as appropriate.

We conducted our review from March 1999 through January 2000 in accordance
with generally accepted government auditing standards.

As agreed with your office, unless you publicly announce the contents of
this report earlier, we plan no further distribution of this report until
30 days after its issue date. At that time, we will send copies of this
report to appropriate congressional committees. We will also send copies to
the Honorable William S. Cohen, Secretary of Defense; the Honorable Togo D.
West, Jr., Secretary of Veterans Affairs; and the Honorable Bernard Rostker,
Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses.
Copies will also be sent to other interested parties upon request.

If you have any questions about this report, please call me at (202)
512-3610 or the contacts listed in appendix VI.

Norman J. Rabkin
Director, National Security
Preparedness Issues

Scope and Methodology

To perform our review, we obtained relevant documents and reports about
potential depleted uranium (DU) health effects from various sources,
including the Department of Defense's (DOD) Office of the Special Assistant
for Gulf War Illnesses; RAND; the U.S. Army Center for Health Promotion and
Preventive Medicine; the Baltimore Veterans Affairs (VA) Depleted Uranium
Follow-up Program; the Persian Gulf Veterans Coordinating Board; the
Department of Veterans Affairs; the Offices of the Surgeons General at the
Army, the Navy, and the Air Force; the Institute of Medicine; and the
National Gulf War Resource Center, Inc. We analyzed this documentation and
discussed in detail issues related to potential DU health effects with
representatives of these organizations.

To identify what is generally known about health effects from exposure to
DU, we analyzed RAND's report, published in 1999, on its review of the
scientific literature about the health effects of depleted uranium. We met
with RAND representatives and discussed the methodology used for its review
and the process used for quality assurance. In addition, we reviewed the
Toxicological Profile for Uranium prepared by the Agency for Toxic
Substances and Disease Registry, a federal agency within the Public Health
Service of the U.S. Department of Health and Human Services, which was
issued in September 1999 after a public comment period. We met with
representatives of the Persian Gulf Veterans Coordinating Board and
discussed federally funded research projects on depleted uranium health
effects. In addition, we met with Institute of Medicine representatives and
discussed the methodology and status of their review of the scientific and
medical literature regarding adverse health effects associated with various
exposures experienced during the Gulf War.

To identify evidence regarding possible negative health effects experienced
by servicemembers as a result of DU exposure during the Gulf War, we
discussed the findings of the Baltimore VA Depleted Uranium Follow-up
Program with program officials and reviewed program documentation. We
discussed with representatives of DOD's Comprehensive Clinical Evaluation
Program and the VA's Persian Gulf Registry completed and planned analyses of
program data related to possible health effects from exposure to DU.

To assess the reasonableness of the DU exposure estimates for servicemembers
involved in DU friendly fire incidents, we reviewed the methodology used by
the U.S. Army Center for Health Promotion and Preventive Medicine at
Aberdeen Proving Ground, Maryland. In analyzing the methodology, we
discussed with Center officials the basis for various components of the
methodology. In reviewing the dose estimation methodology, we also met with
the principal author of a 1989 test report and other officials at the U.S.
Army Picatinny Arsenal to discuss the reasonableness of the Center's use of
data from the earlier test.

To identify whether Gulf War veterans were experiencing administrative
problems in participating in the current DOD/VA DU medical screening
program, we surveyed by telephone servicemembers who had been contacted by
the Office of the Special Assistant for Gulf War Illnesses. The Office of
the Special Assistant contacted those Gulf War veterans believed to have
received the highest levels of exposure to DU to encourage them to
participate in the program. We developed and pretested a structured
interview protocol that we subsequently used in surveying the
servicemembers. As of August 11, 1999, the Office of the Special Assistant
had contacted 210 individuals about the screening program.13 Because of the
difficulty in reaching servicemembers located outside the United States, we
did not attempt to reach the 16 individuals who were located outside the
contiguous United States. We subsequently attempted to contact 194
individuals who were believed to be in the United States at the time of our
survey. We located and interviewed 128 individuals about their experiences
with the medical screening program. We analyzed the survey results and
subsequently communicated information about those instances in which program
administrative problems were cited to DOD and VA officials. We provided DOD
and VA officials an opportunity to investigate the problem cases and provide
us with any documentation that refuted the allegations. In those instances
where the DOD or VA officials provided evidence that effectively refuted the
servicemembers' allegations, we revised our summary results. Specifically,
10 veterans told us about administrative problems that were not
substantiated by information or documentation provided by DOD or VA-- such
as not completing the urine tests, not receiving the test results, and not
being notified to set up an appointment.

To assess whether the services have implemented programs to train
servicemembers on how to operate safely in a DU-contaminated environment, we
interviewed officials and obtained relevant documentation by visiting or
contacting the following locations:

ï¿½ Department of Defense

ï¿½ The Office of the Special Assistant for Gulf War Illnesses, Falls Church,
Va.

ï¿½ Department of the Army

ï¿½ Office of the Deputy Chief of Staff for Operations, Army Training,
Headquarters, Department of the Army, Pentagon, Washington, D.C.

ï¿½ Headquarters, U.S. Army Training and Doctrine Command, Fort Monroe, Va.

ï¿½ Headquarters, U.S. Army Medical Command, Fort Sam Houston, Tex.

ï¿½ Headquarters, U.S. Army Europe, Heidelberg, Germany

ï¿½ Headquarters, 7th Army Training Command, Grafenwoehr, Germany

ï¿½ Headquarters, V Corps, Heidelberg, Germany

ï¿½ U.S. Army Chemical School, Fort Leonard Wood, Mo.

ï¿½ U.S. Army Ordnance Centers and Schools, Aberdeen Proving Ground, Md.

ï¿½ Redstone Arsenal, Ala.

ï¿½ Headquarters, U.S. Army Infantry Center and Fort Benning, Fort Benning,
Ga.

ï¿½ Continental U.S. Replacement Center, Fort Benning, Ga.

ï¿½ U.S. Army Armor Center, Fort Knox, Ky.

ï¿½ U.S. Army Combined Arms Center and Fort Leavenworth, Fort Leavenworth,
Kans.

ï¿½ Department of the Navy

ï¿½ Radiological Controls & Health Branch, Office of the Chief of Naval
Operations, Pentagon, Washington, D.C.

ï¿½ U.S. Navy Bureau of Medicine and Surgery, Washington, D.C.

ï¿½ Chief of Naval Education and Training, Pensacola, Fla.

ï¿½ U.S. Navy Fleet Combat Training Center, Atlantic, Virginia Beach, Va.

ï¿½ Department of the Air Force

ï¿½ Office of the Deputy Assistant Secretary for Environmental Safety and
Occupational Health, Office of the Secretary of the Air Force, Washington,
D.C.

ï¿½ Civil Engineering Directorate, Headquarters, U.S. Air Force, Washington,
D.C.

ï¿½ Office of the Air Force Surgeon General, Bolling Air Force Base,
Washington, D.C.

ï¿½ U.S. Marine Corps

ï¿½ Radiation Safety Office, Marine Corps Safety Division, Headquarters, U.S.
Marine Corps, Arlington, Va.

ï¿½ Health Services, Headquarters, U.S. Marine Corps, Arlington, Va.

ï¿½ Marine Corps Combat Development Center, Quantico Marine Corps Base,
Quantico, Va.

To review the implementation of DU safety training, we focused on the Army
because, as the service with the largest numbers of ground troops, it is the
service with the greatest likelihood of having large numbers of troops
exposed to DU on the battlefield. In reviewing the Army's implementation of
its broadscale DU general awareness training for soldiers, we visited
selected active Army units and reviewed their common task training records
for fiscal year 1999. In performing our review we compared the DU portion of
the common task training records to the unit rosters to determine how many
soldiers in each unit had been trained and tested on DU. Our review included
visits to the 17 units listed below, some of which are rapid deployment
units.

ï¿½ Fort Bragg, North Carolina

ï¿½ A Company, 3rd Battalion, 505th Parachute Infantry Regiment

ï¿½ C Company, 3rd Battalion, 505th Parachute Infantry Regiment

ï¿½ D Company, 3rd Battalion, 505th Parachute Infantry Regiment

ï¿½ Headquarters and Headquarters Company 3rd Battalion, 505th Parachute
Infantry Regiment

ï¿½ D Troop, First Squadron, 17th Cavalry Regiment

ï¿½ C Company, 307th Engineer Battalion

ï¿½ 82nd Military Police Company

ï¿½ C Battery, 3rd Battalion, 4th Air Defense Artillery Regiment

ï¿½ C Company, 82nd Signal Battalion

ï¿½ Headquarters and Service Company, 313th Military Intelligence Battalion

ï¿½ C Company, 27th Engineer Battalion, 20th Engineer Brigade

ï¿½ B Company, 27th Engineer Battalion, 20th Engineer Brigade

ï¿½ C Company, 37th Engineer Battalion, 20th Engineer Brigade

ï¿½ B Battery, 1st Battalion, 377th Field Artillery Regiment, XVIII Airborne
Corps Artillery

ï¿½ C Battery, 1st Battalion, 321st Field Artillery Regiment, XVIII Airborne
Corps Artillery

ï¿½ A Battery, 3rd Battalion, 27th Regiment, XVIII Airborne Corps Artillery

ï¿½ Fort Knox, Kentucky

ï¿½ 233rd Combat Heavy Equipment Transport Company

DOD and VA provided written comments on a draft of this report. These
comments are discussed on page 21 and are reprinted in appendixes IV
and V.

Military Services' Depleted Uranium Safety Training

This appendix describes, in detail, the depleted uranium safety training
developed by each military service.

The Army included DU training for personnel in its M-1 tank Master Gunner
Course in 1991 and in the Armor Officer Basic Course and Armor Captain
Career Course in 1995. Depleted uranium training was introduced into the
noncommissioned officer Ammunition Specialist Course in 1994, and into the
Nuclear, Biological, and Chemical Course in 1995. In 1996, DU training was
added to four different ordnance courses and to the Army's Ammunition
Technician Course. DU training was introduced into the Infantry Bradley
Fighting Vehicle Course in 1997 and into two additional Bradley vehicle
courses in 1999. In 1998, DU training was included in the Army's Pre-Command
Course for Lieutenant Colonels and Colonels prior to their first command
assignment. Army officials could not give the actual date for when DU
training was included in the Advanced Individual Training course for
explosive ordnance disposal personnel or the core level Ammunition
Specialist Course, but they said DU was not introduced into these two
courses until after the Gulf War.

In October 1998, DU training was included as a common task in the Army's
list of required unit-level training tasks, and DU will be included in the
common task test for a 5-year period from fiscal year 1999 to 2003. In
addition, on three different occasions in 1999, the Army used its worldwide
satellite broadcasting system to televise DU training information to Army
units worldwide. The same system was used on two earlier occasions in 1998
to broadcast DU-related medical treatment information to military medical
personnel in all the services worldwide. In April 1999, the Army Medical
Command established a requirement that all physicians and other applicable
health care providers be trained on the Army's policy for treating personnel
wounded by depleted uranium munitions. Also, as of February 2000, according
to the Army's Training and Doctrine Command, DU training is now a mandatory
part of officer precommissioning training for all new officers, and warrant
officers will receive mandatory DU training during preappointment training
as well.

During our visit to units at Fort Bragg, N.C., the XVIII Airborne Corps
Chemical Officer told us that the Corps conducts a 2-week training course to
train alternate nuclear, biological, and chemical officer and
noncommissioned officer personnel from individual units at Fort Bragg, and
that the course began including DU training informally in October 1998 and
formally in 1999. He also said that other corps and division size Army units
may have similar training courses. In addition, the 82nd Airborne Division's
Chemical Officer told us that, given the current emphasis on DU, the
division is planning to incorporate DU training into its predeployment
checklist of required items to accomplish before a unit deploys. This is
being done as an additional assurance that deploying personnel will receive
DU training, even if they miss it as part of common task training.

The Air Force provided DU training as part of its nuclear radiation and
hazardous materials training to bioenvironmental engineers and in the
training curriculum for personnel with potential for exposure to DU as part
of their military occupation (e.g., it has been provided for explosive
ordnance personnel since before the Gulf War). In 1998, the Air Force began
including DU training as a unit training requirement as part of its annual
nuclear, biological, and chemical refresher training for all officer and
enlisted personnel subject to deployment. In October 1999, DU training was
added to Air Force basic recruit training. In addition, the Air Force
Surgeon General made DU training a continuing medical education requirement
by requiring that all Air Force medical personnel be trained annually in how
to treat personnel wounded by DU munitions.

The only Navy weapons system that uses DU munitions is the Phalanx
Close-in-Weapons System, a shipboard, rapid-firing 20 millimeter cannon
designed to shoot down incoming missiles. The Navy is phasing out its use of
DU rounds over the next 5 years because it has determined that the
penetration capability of DU rounds is not necessary for shooting down
missiles because they are lightly armored. Since the introduction of the
Phalanx around 1980, the Navy has provided DU training to its fire control
technicians who operate the system and who store and handle DU ammunition.
Recognizing that other countries now have DU rounds and that its ships may
be hit by DU rounds, the Navy made DU general awareness training a unit
training requirement and a predeployment training requirement beginning in
the fall of 1999 for all shipboard damage control personnel, firefighters,
and medical personnel. In addition, explosive ordnance personnel, special
operations personnel, and Seabees are now required to be provided DU
training prior to each deployment or as part of annual refresher training.
In addition to the general awareness training, deploying Navy medical
personnel must also receive information on the treatment of personnel
wounded by DU.

The Marine Corps decided to wait until the Army had completed the DU
training materials before providing DU training to its troops on a broad
scale. In October 1998, the Marine Corps began providing DU training to
personnel who have completed basic recruit training and are waiting to enter
either the Marine Corps School of Infantry or a military occupational
training program such as armor, ordnance, ammunition technician, or aircraft
maintenance. In fiscal year 2000, Marine Corps officers are scheduled to
begin receiving DU training as part of their entry-level officer training.
DU training will also be introduced into advanced officer training courses
and schools such as the Marine Corps War College, Marine Corps Commanders'
Course, Marine Corps Command and Staff College, and the Amphibious Warfare
School. Marine Corps noncommissioned officers will receive DU training in
their noncommissioned officer courses, also beginning in fiscal year 2000.
In addition, the Marine Corps plans to provide DU training to every Marine
beginning in fiscal year 2000 by including DU training as one of its
critical combat and survival skills, which are taught, tested, and
periodically retrained in individual Marine Corps units (battalion level or
below). Marine Corps units have a 2-year cycle for accomplishing this
training. The Navy provides the Marine Corps with medical support; Navy
medical personnel receive DU training as discussed earlier in the section on
Navy DU training efforts.

Army's Implementation of Common Task Test--Depleted Uranium Training
Requirement

This appendix presents in table 1 the results of our review of selected Army
units' compliance with the Army's Common Task Test--Depleted Uranium
Training for fiscal year 1999 at Fort Bragg, North Carolina, and Fort Knox,
Kentucky.

Table 1: Number and Percentage of Unit Personnel Completing Army's Required
Common Task Test−Depleted Uranium for Fiscal Year 1999 for Selected
Army Units

       Number in unit
 Unit  subject to Common Number completing Percentage completing
       Task Test         DU training       DU training
 Fort Bragg
 A     133               109               82
 B     122               111               91
 C     69                56                81
 D     176               175               99
 E     10                7                 70
 F     108               65                60
 G     82                37                45
 H     101               74                73
 I     99                95                96
 J     59                44                75
 K     79                55                70
 L     89                78                88
 M     100               0                 0
 N     104               95                91
 O     89                0                 0
 P     89                70                79
 Fort Knox
 A     132               0                 0
 Total 1,641             1,071             65

Source: GAO.

Comments From the Department of Defense

Comments From the Department of Veterans Affairs

GAO Contacts and Staff Acknowledgments

Christine A. Fossett (202) 512-2956

In addition to the name above, Derek Stewart, Steve Fox, Leo Jessup, Lynn
Johnson, William Mathers, and Jack Edwards made key contributions to this
report.

(703277)

Table 1: Number and Percentage of Unit Personnel Completing
Army's Required Common Task Test-Depleted Uranium for
Fiscal Year 1999 for Selected Army Units 32

Figure 1: 120-mm Armor Piercing Round With DU Penetrator 6
  

1. Program clinical investigators cautioned that the number of veterans with
elevated uranium levels was small and that a few veterans with complex
histories may have contributed appreciably to the observed variance.

2. Environmental Exposure Report: Depleted Uranium in the Gulf, Office of
Special Assistant for Gulf War Illnesses (Washington, DC: Aug. 1998).

3. Melissa A. McDiarmid, et al., "Health Effects of Depleted Uranium on
Exposed Gulf War Veterans," Environmental Research, Vol. 82 (2) (Feb. 2000),
pp. 168-180.

4. A Review of the Scientific Literature as It Pertains to Gulf War
Illnesses, Vol. 7, Depleted Uranium, prepared by RAND's National Defense
Research Institute for the Office of the Secretary of Defense (Santa Monica,
Calif.: 1999), and Toxicological Profile for Uranium (Update), prepared by
Research Triangle Institute for Agency for Toxic Substances and Disease
Registry, U.S. Department of Health and Human Services, Public Health
Service (Atlanta, Ga.: Sept. 1999). The Agency's toxicological profile was
prepared pursuant to section 104(i) of the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980, 42 U.S.C. sect. 9604(i)
(1994), for hazardous substances found at Department of Energy waste sites,
including the toxicologic and adverse health effects for uranium.

5. Information reported to date on the health effects of DU from this
program are based on findings from 29 of the original 33 participants who
have been monitored since the program began in 1993. More recent results
should be available during the summer of 2000. These results will be based
on medical evaluations conducted between March and July 1999 of 51
participants, including 21 of the original participants.

6. Persian Gulf War Veterans Act of 1998, P. L. 105-277, sect.1603, 112 Stat.
2681, 2681-745 (Oct. 21, 1998) and Veterans Programs Enhancement Act of
1998, P. L. 105-368, sect. 101, 112 Stat. 3315, 3317 (Nov. 11, 1998), each of
which mandates a review regarding the associations between illnesses and
Gulf War service.

7. Richard L. Fliszar, Edward F. Wilsey, and Ernest W. Bloore, Radiological
Contamination From Impacted Abrams Heavy Armor, U.S. Army Laboratory
Command, Ballistic Research Laboratory, Technical Report BRL-TR-3068
(Maryland: Dec. 1989).

8. On September 24, 1999, Representative Lane Evans, Representative Bob
Filner, and Senator Russell Feingold cosigned a letter to the Secretary of
Defense requesting the Secretary to immediately investigate the issue and to
direct a new dose reconstruction, if appropriate.

9. We did not attempt to interview 16 veterans because they were located
outside the contiguous United States when we were doing our survey.

10. The 24-hour urine test identifies the uranium level in a urine sample
collected over a
24-hour period.

11. Operation Desert Storm: Army Not Adequately Prepared to Deal With
Depleted Uranium Contamination (GAO/NSIAD-93-90 , Jan. 29, 1993).

12. Common task training includes a number of critical combat and survival
skills in which the Army requires all soldiers to be routinely trained and
tested--every year for active soldiers and every 2 years for reserve
soldiers.

13. The Office of the Special Assistant has continued to notify veterans
about the program. From August 1999 to January 2000, the Office of the
Special Assistant contacted 12 additional veterans. As discussed in the
report, DOD and VA have made this program available to any Gulf War veteran
who believes that he or she may have been exposed to DU. As of December 31,
1999, a total of 269 veterans have entered the screening program through
this avenue as self-referrals.
*** End of document. ***