Gulf War Illnesses: Basic Questions Unanswered (Testimony, 02/02/2000,
GAO/T-NSIAD-00-79).

Pursuant to a congressional request, GAO discussed the expenditures by
the Departments of Defense (DOD), Veterans Affairs (VA), and Health and
Human Services (HHS) on Gulf War veterans' illnesses, focusing on the :
(1) amount of money that these three departments spent in fiscal years
1997 and 1998 on research and investigation into Gulf War veterans'
illnesses and health concerns; (2) results of the research and
investigation spending; (3) extent of coordination between the
Coordinating Board's Research Working Group and DOD's Office of the
Special Assistant for Gulf War Illnesses; and (4) management of
contracts supporting DOD's Office of the Special Assistant.

GAO noted that: (1) during fiscal years 1997 and 1998, VA, HHS, and DOD
spent more than $121 million for research and investigation into Gulf
veterans' illnesses; (2) DOD spent $112 million of this total, mostly
through its Office of the Special Assistant for Gulf War Illnesses; (3)
results of the research and investigation activities are accruing slowly
and basic questions about the causes, course of development, and
treatments of Gulf War veterans' illnesses remain unanswered; (4) the
activities of the Office of the Special Assistant are not effectively
coordinated with those of the Research Working Group; and (5) work was
improperly awarded to the Office's support contractors for task worth
more than $20 million.

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

 REPORTNUM:  T-NSIAD-00-79
     TITLE:  Gulf War Illnesses: Basic Questions Unanswered
      DATE:  02/02/2000
   SUBJECT:  Armed forces abroad
	     Medical research
	     Interagency relations
	     Contract administration
	     Chemical warfare
	     Biological warfare
	     Hazardous substances
	     Disease detection or diagnosis
	     Veterans
	     Budget outlays
IDENTIFIER:  Gulf War Syndrome
	     Persian Gulf War

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Before the Subcommittee on National Security, Veterans' Affairs, and
International Relations, Committee on Government Reform, House of
Representatives

For Release on Delivery

Estimated at

10:00 a.m., EST

Wednesday,

February 02, 2000

GULF WAR ILLNESSES

Basic Questions Unanswered

Statement of Kwai-Cheung Chan, Director, Special Studies and Evaluations,
National Security and International Affairs Division

GAO/T-NSIAD-00-79

Mr. Chairman and Members of the Subcommittee:

We are pleased to be here today to discuss our recently completed report on
the research and investigations conducted on Gulf War veterans' illnesses.
Many of the approximately 700,000 Gulf War veterans have complained of
illnesses since the war's end in 1991, and over 10 percent have completed
health examinations through the Department of Veterans' Affairs (VA) or
Department of Defense (DOD). Some are concerned they are suffering from
chronic disabling conditions because of exposures during the war to agents
with known or suspected effects on health. In response to this concern, the
government has funded research, investigation, and information activities
through various agencies, including DOD, VA, and the Department of Health
and Human Services (HHS). These agencies participate in an interagency
group, the Persian Gulf Veterans' Coordinating Board, which was established
in 1994 to coordinate these activities. The Coordinating Board's Research
Working Group, currently chaired by the Department of Veterans' Affairs,
focuses on research planning, review, and dissemination, but it is not
authorized to manage or distribute the Departments' research funds. In 1996,
DOD established the Office of the Special Assistant for Gulf War Illnesses
to oversee DOD's efforts regarding illnesses being experienced by Gulf War
veterans.

As requested, today we will discuss the expenditures on these efforts by the
Departments of Defense, Veterans' Affairs, and Health and Human Services and
our work to evaluate their results. Specifically, we determined

   * the amount of money that these three departments spent in fiscal years
     1997 and 1998 on research and investigation into Gulf War veterans'
     illnesses and health concerns,

   * the results of the research and investigation spending,

   * the extent of coordination between the Coordinating Board's Research
     Working Group and DOD's Office of the Special Assistant for Gulf War
     Illnesses, and

   * the management of contracts supporting DOD's Office of the Special
     Assistant.

SUMMARY

I will briefly summarize our four principal findings before providing more
detail.

   * First, during fiscal 1997 and 1998, the Departments of Veterans'
     Affairs, Health and Human Services, and Defense spent more than $121
     million for research and investigation into Gulf veterans' illnesses.
     The Defense Department spent $112 million of this total, mostly through
     its Office of the Special Assistant for Gulf War Illnesses.
   * Second, results of the research and investigation activities are
     accruing slowly and basic questions about the causes, course of
     development, and treatments of Gulf War veterans' illnesses remain
     unanswered.
   * Third, the activities of the Office of the Special Assistant are not
     effectively coordinated with those of the Research Working Group.

   * Finally, work was improperly awarded to the Office's support
     contractors for tasks worth more than $20 million.

DOD SPENT MOST OF THE RESEARCH AND INVESTIGATION FUNDS

DOD spent most of the $121 million used for Gulf War research and
investigation by the three agencies in fiscal 1997 and 1998. The Department
of Health and Human Services reported it spent less than $2 million, the
Department of Veterans' Affairs $7 million, and DOD $112 million. These
amounts exclude expenses for examinations and clinical care of ill veterans.
Within DOD, the Office of the Special Assistant spent the largest amount,
$65 million, while other activities, such as the medical research efforts
catalogued by the Research Working Group, accounted for $47 million.

Representatives of the Office of the Special Assistant told us that the
Office had projected spending $36 million in fiscal 1999 and $30 million in
fiscal 2000. These officials told us in 1998 that they were seeking the
guidance of the President's Special Oversight Board on DOD Investigations of
Chemical and Biological Incidents to determine what portion of the Office's
investigative work should continue and how it should reduce the role of the
Office. However, funding for the Office is included in DOD's budget through
fiscal 2005.

BASIC QUESTIONS ABOUT VETERANS' ILLNESSES REMAIN UNANSWERED

Regarding the results to date of the three Departments' research and
investigations, we have several observations. First, as of November 30,
1999, the Research Working Group of the Persian Gulf Veterans' Coordinating
Board had not published an assessment of the extent to which the research
agenda has satisfied the objectives it identified in 1995. These objectives
include questions about the prevalence of specific health problems and
exposures among the veteran population and the way the prevalence differs
between Gulf War veterans and appropriate control populations. We
recommended, and agency officials agreed, that a date should be established
in 2000 for publication of this assessment.

Also, while findings from research are beginning to accumulate, most of the
sponsored studies are ongoing or in review. By mid-1999, of the 151 research
projects monitored by the Research Working Group, 70 percent were still
ongoing, including 19, or about 30 percent of the 62 that were scheduled for
completion by then. Group officials attributed the extended completion dates
either to efforts to collect or incorporate additional data or to
unanticipated delays, such as difficulties in securing approval to collect
data or problems in locating and recruiting veteran participants.

In addition, DOD's Office of the Special Assistant for Gulf War Illnesses
had received 19 of the 20 reports due from its major research contractors.
However, only 6 had been publicly released; the remainder was largely in
various stages of interagency review. Fourteen of these reports had remained
in draft or review status for a year or longer.

While federally sponsored studies have resulted in some descriptive
information concerning veterans' symptoms, many basic questions remain.
Identification of the potential causes of veterans' unexplained symptoms has
been difficult because researchers are faced by persistent problems in
ascertaining veterans' specific exposures. In addition, the Research Working
Group has not endorsed any case definition or set of such definitions that
might focus federal research. These difficulties led us to conclude in our
1997 report that the many epidemiological studies being sponsored would not
provide definitive information on the causes of veterans' illnesses. In
particular, difficulty in accurately classifying veterans by the levels of
their exposure to specific agents makes it hard to detect associations
between exposures and health outcomes.

Other basic questions remain unanswered 9 years after the veterans returned
home. As early as 1994, a National Institutes of Health Work Group that met
to consider research needs on Gulf War veterans' illnesses, observed that
better estimates of the prevalence of symptoms were desirable. In 1997, we
noted -- as did the Special Investigative Unit of the Senate Veterans'
Affairs Committee -- that open questions included how many of the veterans
who had been examined had unexplained illnesses or symptoms. However, a
September 1999 report of the Institute of Medicine noted that no systematic
evaluation has been done to determine whether or how veterans' health status
is changing. Also, in its 1998 report to Congress, the Research Working
Group acknowledged that no government research is specifically directed
toward understanding the progress of Gulf War veterans' illnesses over time
and that research should assess the long-term health of these veterans.

Some data that might be helpful in answering such questions are being
collected as part of a national health survey of Gulf War veterans being
conducted by VA, but an analysis of these data was not available at the
close of our review. In addition, an HHS-sponsored project, which began in
1997, is assessing the persistence and stability of veterans' symptoms over
time. This study is planned to end in 2000.

We recommended that steps be completed to compile data on the number of Gulf
War veterans with unexplained illnesses, the treatments they were receiving,
and the success of these treatments. DOD partially concurred with this
recommendation and VA did not concur. Neither agency opposed the collection
of information on the number and health status of Gulf War veterans with
unexplained illnesses. However, VA stated that it could not implement the
recommendation as worded without specific case definitions (that is,
criteria to identify distinct illnesses). DOD objected that veterans'
illnesses were not amenable to a single, unifying case definition. Although
consensus on a single definition

would simplify this task, it is not essential. Nonetheless, we agree that
some categorization scheme or set of working case definitions will be useful
in counting the numbers of veterans that have unexplained illnesses of some
type and we revised our recommendation to reflect this. In September 1999,
the Institute of Medicine issued a report to VA which recommended a
methodology for measuring veterans' health status. This approach is
consistent with our recommendation that VA and DOD select a strategy for
answering this question and compile the appropriate data.

ACTIVITIES ARE NOT EFFECTIVELY COORDINATED

The Office of the Special Assistant's activities have not been effectively
coordinated with those of the Research Working Group to maximize the
efficient use of resources. Group and Office representatives stated that the
Office's activities involve investigations, not research, and were therefore
not subject to coordination. However, in a 1997 letter to the Office of the
Special Assistant, the Research Working Group clearly regarded some of the
Office's activities as research. Regardless of whether the work of the
Office is considered research or not, it describes the extent and nature of
veterans' possible exposures to hazardous materials. Characterizing
veterans' exposures is the focus of several of the research objectives the
Group established in 1995, and the Office's investigations of potential
exposures should be germane to researchers trying to identify the
consequences of such exposure.

The lack of effective coordination between the Group and the Office also
increases the potential to miss opportunities to take advantage of ongoing
and completed work by other agencies. For example, in January 1998, the
Institute of Medicine presented a proposal to VA, which was funded under a
congressional mandate, to pursue studies at a projected cost of $1.25
million to review, evaluate and summarize the available scientific and
medical information regarding the association between Gulf War veterans'
exposures and the adverse health effects they had experienced. However, in
1997, the Office of the Special Assistant contracted with RAND at a cost of
more than $1.5 million to conduct a similar review. In addition, the three
Departments separately funded reviews of the health effects of depleted
uranium. Better coordination of these efforts might have saved both time and
money.

To prompt these offices to work more closely on behalf of all veterans, we
have recommended that the three Department secretaries direct the Executive
Director of the Research Working Group to effectively coordinate the efforts
of the Office of the Special Assistant for Gulf War Illnesses with related
activities of DOD, VA, and HHS to prevent duplication and improve the
efficiency of resource use. We believe that greater cooperation, exchange of
information, and coordination will help expedite the process and help find
solutions the veterans need.

CONTRACTING FOR THE OFFICE'S SUPPORT SERVICES WAS FLAWED

With regard to the management of contracts supporting the Office, we
reviewed four support agreements, which accounted for more than 91 percent
of the $47 million the Office spent for support services. We found that two
task orders worth over $20 million were awarded improperly, and the Office
discouraged competition for another task order by specifying a preferred
vendor. Because the Office is likely to continue to spend a significant part
of its budget on support contracts, the Office needs to ensure that its
contracts fully comply with applicable requirements.

We recommended that the Secretary of Defense direct the Office of the
Special Assistant to replace an improperly awarded task order with a proper
contracting arrangement as soon as practicable. Finally, we recommended that
the Secretary direct the Office that all future support contracts should
comply fully with applicable laws and regulations. DOD did not concur with
these recommendations, stating that the Office of the Special Assistant does
not have its own contracting officers and relied on the judgment of
contracting professionals outside the office, who did not object to the
Office's contract actions. We recognize that the Office of the Special
Assistant relies on contracting professionals outside the office to execute
its support contracts. Nevertheless, the office is, at a minimum,
responsible for determining its requirements for support, a process that in
one instance resulted in naming a preferred vendor and in another led to an
overly broad statement of work. The effect of these practices is to
discourage competition. It is important that both requiring agencies, such
as the Office, as well as agencies that execute contracts, adhere to the
statutes and regulations designed to maximize competition.

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

Mr. Chairman, this concludes my statement. I would be happy to answer any
questions you may have.

Contacts and Acknowledgments

For future questions regarding this testimony, please contact Kwai-Cheung
Chan at (202) 512-3652. Individuals making key contributions to this
testimony included Dr. Sushil K. Sharma and Dr. Betty Ward-Zukerman.

(713045)
  
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