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testimony on the health effects of 

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exposure to airborne hazards , 

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including toxic fumes from burn pits . 

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Let me start by welcoming ranking 

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member Tillis who will be here very 

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shortly . Who has been an excellent 

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partner on this subcommittee over the 

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last several years , Senator Tillis and 

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I have shared a commitment to 

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supporting our service members and 

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providing them with the services , 

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resources and care that they need . 

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That commitment extends to our shared 

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drive to address the debilitating and 

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extensive medical issues and 

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disabilities caused by the use of burn 

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pits in recent combat operations . When 

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our service members deployed , they 

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expect to face risks . But those risks 

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should not come from the operations of 

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our own bases and when they do , we 

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must take responsibility . I look 

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forward to continuing to work together 

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on this issue . I was also glad to hear 

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that President biden prioritized 

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addressing this cost of war in the 

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state of the Union and again in texas 

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last week , he described the clear 

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cause and effect of this crisis , 

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saying quote , the burn pits that 

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incinerate the waste of war , medical 

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and hazardous material , jet fuel and 

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so much more were just dug in big pits , 

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not far from where our veterans were 

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sleeping and when our troops came home , 

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the fittest among them , the greatest 

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fighting force in the history of the 

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world . Too many of them were not the 

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same headaches , numbness , dizziness , 

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cancer that tells the whole story . Men 

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and women who deployed at the peak of 

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physical fitness are now fighting to 

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survive . This is the this is a health 

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crisis among our armed services . Most 

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public attention on this issue has been 

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focused on the treatment of veterans at 

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the Veterans Administration , but these 

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health issues stem from time on active 

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duty and can begin presenting while our 

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troops are still serving . The D . O . 

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D . Has a critical role to play in 

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protecting the health of our current 

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and transitioning service members . 

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That's why today's hearing is so 

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critical . We need to have a better 

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understanding of how toxic exposure has 

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been and is being tracked and 

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documented and the barriers that have 

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prevented that documentation from being 

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done effectively . Congress has already 

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recognized DS DS responsibility and has 

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passed legislation to require D . O . D . 

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To take appropriate measures including 

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requiring inclusion of exposure to open 

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burn pits in post deployment . Health 

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assessment of service members returning 

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from deployment , recording , burn pit 

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registration and electronic health 

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records and mandatory training for 

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military healthcare providers on the 

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effects of burn pit exposure . But we 

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need to go further . We need to build 

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an understanding of the health impacts 

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of toxic exposure and our knowledge of 

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when such exposures occurring . And we 

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must make that information available to 

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service members , their families and 

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the medical profession's professionals 

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they rely on in order to properly and 

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adequately care for our troops who have 

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been exposed . As President biden said , 

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quote , we need to know more about 

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which of our veterans may have been 

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exposed to burn pits in the first place 

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or other environmental toxins during 

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their service and record possible 

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exposure before service members 

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separate from the military and quote , 

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today's witnesses will help provide 

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clarity in both of those areas are . 

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First panel consists of D . O . D . 

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Witnesses who have testified about the 

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health effects of toxic exposure , 

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assessment of health impacts , 

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documentation of potential exposure and 

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monitoring of exposure witnesses on our 

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second panel will share what they have 

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seen or experienced firsthand on this 

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issue and will provide recommendations 

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for ensuring the health and safety of 

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our service members . Witnesses for our 

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first panel include Dr Terry M . Roush , 

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acting deputy assistant secretary of 

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Defense for health readiness policy and 

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oversight . Dr Raul Mirza , division 

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Chief of occupational environmental 

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Medicine , Clinical Public Health and 

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epidemiology , US Army Public Health 

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Center . Colonel Adam Newell . Adam Jay 

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Newell , Chief of Medical readiness Air 

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Force Medical readiness Agency and 

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Captain BRian L . Feldman , Commander , 

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Navy and Marine Corps Public Health 

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Center . I'll introduce the second 

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panel . I have to receive the testimony 

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of the first panel again . Thank you 

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for being here today and um just for 

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senator , tell us his benefit , I told 

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them how wonderful you are at the 

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opening of my remarks . Could you 

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please repeat that ? Uh And I'm sorry 

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I'm running late . I went ahead and 

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voted so I figured we could tag team 

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and not disrupt the hearing but thank 

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you all for being here . Senator 

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Gillibrand , thank you for holding the 

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hearing and your advocacy of the work 

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that I'm well aware of and veterans 

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affairs that we need to continue to 

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work on . I've worked on this subject 

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for a long time when I first came to 

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the Senate , I was involved with trying 

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to get the Presumptions in place for 

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camp Lejeune toxic exposures down there , 

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fortunately after um , a lot of back 

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and forth with the V . A . We were 

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successful , but we have more work to 

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do . And I'm happy that the Veterans 

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Affairs Committee has unanimously 

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reported out a bill on toxic substances . 

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We're going to continue to work in the 

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V . A . Committee to do right by those 

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who were exposed and who are now in 

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veteran status . The the objective of 

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today's hearing though . And it's 

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something that I've said um on a number 

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of fronts , whether it's traumatic 

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brain injury , low level , low level 

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concussive events , things that men and 

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women while they're inactive status 

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experience that could ultimately result 

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in problems in the long term . I think 

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we have an opportunity to hear to get 

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ahead of it instead of waiting for the 

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next burn pit are waiting for the next 

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agent Orange , What more can we do 

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downrange ? What war can we do in our 

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military installations to understand 

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the potential risk that we're 

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putting our men and women um , 

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potentially putting them in a position 

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to where they too are going to have 

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negative health consequences either 

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while they're serving or after they 

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transition a veteran status . So today 

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I look forward to talking with you all 

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about how we can get ahead of the curb 

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how we can do a better job of tracking 

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potential exposure so that it makes it 

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very easy later on . If we get into a 

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situation we can't always , when we're 

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downrange know what we're going to get 

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exposed to . But once we know it , then 

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we should make sure that every single 

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electronic health record of any man or 

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woman who's exposed to it is updated 

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and maybe we can even anticipate that 

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they're at risk before they ever 

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exhibit the first symptom . That's the 

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end goal . And I'm sure that I I uh 

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that that you all the witnesses agree 

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that that should be an end goal of 

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everybody . Um so I look forward to 

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this testimony today . I look forward 

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to moving up in the cycle talking with 

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the D . O . D . To figure out what more 

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we can do to actually begin to bend the 

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curve on some of the consequences that 

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we have to deal with with our men and 

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women in uniform and with the men and 

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women who have served before . So thank 

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you all look forward to your testimony . 

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Colonel Newell . Right , 

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well , dr Roush , I got 

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it . Chairwoman Jilib 

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earn ranking member tell us and members 

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of the subcommittee . Thank you for 

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inviting the department to testify for 

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the Senate Armed Services committee 

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hearing on military exposures of 

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concern , including airborne hazards 

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and open burn pits . I'm pleased to 

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represent the office of the Secretary 

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of defense and have the opportunity to 

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discuss the department's actions in 

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addressing airborne contaminants and 

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open burn pits in military operations 

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and the potential health effects to our 

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service members and veterans joining me 

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today in representing their military 

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departments are Colonel New new from 

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the Air Force DR MErcer from the Army 

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and Captain Feldman from the Navy . The 

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department recognizes the concerns 

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about the potential health impact of 

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burn pits and other airborne exposures . 

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The relationship between burn pit 

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exposure and illness is a topic of 

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active research by the department , the 

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via national Academies of 

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Science Engineering and Medicine and 

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other research institutions . The 

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department and via continued to support 

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and fund these research efforts to 

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better understand any health effects 

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that will better inform the health care 

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provided to our service members and 

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veterans healthcare providers play a 

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critical role in understanding 

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health related exposures in becoming 

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proficient in assessing patients 

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exposure concerns . This month the 

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department will launch an updated 

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version of its airborne hazards and 

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open burn pit registry overview 

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course for healthcare providers . In 

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addition to the training course , an 

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airborne exposure clinical toolbox is 

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available to our healthcare providers . 

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The department and the B . A . 

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Continued to share education training 

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and outreach products to improve 

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exposure related clinical care . 

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Airborne hazards pose potential acute 

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and chronic health effects during 

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deployment and post deployment as such . 

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The department has enhanced its pre and 

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post deployment related health 

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assessments and the 

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separation health assessment 

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to include more specific 

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occupational and environmental exposure 

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questions including questions on burn 

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pits and other airborne hazards . The 

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department and via are currently 

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collaborating on multiple efforts 

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including the development of the first 

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ever individual longitudinal exposure 

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record . We call it the island , 

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providing exposure summaries by 

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leveraging personnel location , 

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environmental monitoring and health 

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assessment data . The department is 

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also conducting a comprehensive 

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exposure monitoring capabilities based 

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assessment aimed at improving 

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individual and area exposure monitoring 

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and record keeping across the 

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installation , training and deployed 

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environments . In closing the 

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department remains committed to 

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continually improving our understanding 

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of exposures of concern and potential 

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health effects in order to prevent and 

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mitigate exposures and clinically 

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assess treat and care for our service 

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members and veterans 

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Madam . Chair Woman that concludes my 

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opening remark and we stand ready to 

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address your questions . Thank you so 

281
00:11:31,630 --> 00:11:34,390
much . Dr Rowsch um dr rash , what does 

282
00:11:34,390 --> 00:11:36,780
D . O . D do in the field to track 

283
00:11:36,790 --> 00:11:39,190
toxic exposure for individual service 

284
00:11:39,190 --> 00:11:41,357
members ? And are there any innovative 

285
00:11:41,357 --> 00:11:43,690
ways the department is working to do so ? 

286
00:11:43,940 --> 00:11:46,730
Thank you for the question . Um I'll 

287
00:11:46,730 --> 00:11:50,520
start off and my colleagues can um can 

288
00:11:50,520 --> 00:11:54,230
provide any any more detail . It 

289
00:11:54,230 --> 00:11:56,460
primarily starts if we're talking about 

290
00:11:56,460 --> 00:11:58,682
the deployed environment , it primarily 

291
00:11:58,682 --> 00:12:00,960
starts on site with our preventive 

292
00:12:00,960 --> 00:12:04,160
medicine teams that are collecting 

293
00:12:04,540 --> 00:12:08,240
um environmental data whether it be 

294
00:12:08,350 --> 00:12:12,250
airborne data , soil 

295
00:12:12,250 --> 00:12:15,760
data , water data and all of that data 

296
00:12:15,760 --> 00:12:17,940
that's being collected . And it could 

297
00:12:17,950 --> 00:12:20,910
and it does obviously include data 

298
00:12:20,910 --> 00:12:23,760
that's generated from military 

299
00:12:23,760 --> 00:12:27,100
operations to include burn pits where 

300
00:12:27,100 --> 00:12:30,950
there are um That data is 

301
00:12:30,960 --> 00:12:33,820
collected by our preventive medicine uh 

302
00:12:33,830 --> 00:12:37,220
units . It's um captured in a 

303
00:12:37,220 --> 00:12:40,150
large database called doors 

304
00:12:40,740 --> 00:12:44,410
and and specific to doors . It's 

305
00:12:44,410 --> 00:12:46,890
called doors . Ih Ih stands for 

306
00:12:46,890 --> 00:12:50,320
industrial hygiene and that that 

307
00:12:50,330 --> 00:12:53,160
database will then 

308
00:12:53,640 --> 00:12:57,620
become available um to 

309
00:12:57,630 --> 00:13:01,560
then feed into the Isler which is the 

310
00:13:01,560 --> 00:13:05,390
longitudinal exposure record . Um 

311
00:13:05,400 --> 00:13:08,050
And in addition , the island will not 

312
00:13:08,050 --> 00:13:10,930
only scrape environmental health 

313
00:13:10,930 --> 00:13:14,720
assessment data from doors , it 

314
00:13:14,720 --> 00:13:18,140
will also scrape data from personnel 

315
00:13:18,140 --> 00:13:20,730
locations . So you can match you can 

316
00:13:20,730 --> 00:13:23,360
match the individual service member and 

317
00:13:23,370 --> 00:13:25,550
his or her location to the 

318
00:13:25,550 --> 00:13:27,760
environmental health data that's being 

319
00:13:28,320 --> 00:13:32,280
captured indoors . And it will 

320
00:13:32,280 --> 00:13:35,080
then island will then present that data 

321
00:13:35,090 --> 00:13:38,540
in a what we call longitudinal um a 

322
00:13:38,540 --> 00:13:41,250
joint and longitudinal viewer and 

323
00:13:41,250 --> 00:13:44,240
summarize that data for the healthcare 

324
00:13:44,240 --> 00:13:47,180
professional . So he or she will be 

325
00:13:47,180 --> 00:13:49,960
able to see where that service member 

326
00:13:49,970 --> 00:13:53,220
was at any point in time what they 

327
00:13:53,220 --> 00:13:56,760
were exposed to . Um 

328
00:13:56,780 --> 00:13:59,700
And then what is the time point this 

329
00:13:59,700 --> 00:14:02,770
data starts your data going back to 

330
00:14:02,770 --> 00:14:05,810
what point in time ? Um Well preventive 

331
00:14:05,810 --> 00:14:09,630
medicine units are are part 

332
00:14:09,640 --> 00:14:13,580
of the deployed force and so they 

333
00:14:13,580 --> 00:14:15,960
could be doing their environmental 

334
00:14:15,960 --> 00:14:18,240
health health assessments on a weekly 

335
00:14:18,240 --> 00:14:20,670
basis . They could be hanging air 

336
00:14:20,670 --> 00:14:22,726
monitor monitor . When did you start 

337
00:14:22,726 --> 00:14:24,003
collecting this data ? 

338
00:14:26,140 --> 00:14:30,060
Um When I was on active duty and 

339
00:14:30,540 --> 00:14:33,720
1999 We were collecting it in Bosnia 

340
00:14:33,720 --> 00:14:37,390
and Kosovo . Now you mentioned also 

341
00:14:37,400 --> 00:14:40,040
so you have it back to 1999 at least . 

342
00:14:40,050 --> 00:14:43,650
And you said there are active burn pits 

343
00:14:43,650 --> 00:14:45,872
today that you're monitoring . Where do 

344
00:14:45,872 --> 00:14:47,761
those , where are those burn pits 

345
00:14:47,761 --> 00:14:50,660
located ? It's my understanding that um 

346
00:14:51,040 --> 00:14:52,929
there are active burn pits in the 

347
00:14:52,929 --> 00:14:56,320
centcom area of operations . I can 

348
00:14:56,320 --> 00:14:58,850
provide more I can get with with 

349
00:14:58,860 --> 00:15:01,360
centcom and we can provide more 

350
00:15:01,740 --> 00:15:04,210
detailed information because I 

351
00:15:04,210 --> 00:15:06,377
understood that the D . O . D . Now as 

352
00:15:06,377 --> 00:15:08,543
a matter of policy has determined that 

353
00:15:08,543 --> 00:15:10,710
they will no longer use burn pits as a 

354
00:15:10,710 --> 00:15:13,280
way to dispose of waste . So if that's 

355
00:15:13,280 --> 00:15:15,391
not the case I just need to know that 

356
00:15:15,391 --> 00:15:17,840
and second I would like to know all 

357
00:15:17,840 --> 00:15:20,440
existing burn pits that are members of 

358
00:15:20,440 --> 00:15:22,440
the military being exposed to today 

359
00:15:22,440 --> 00:15:24,718
because that would be of great concern . 

360
00:15:24,718 --> 00:15:26,884
Market was so calm . I'll provide that 

361
00:15:26,884 --> 00:15:29,218
that information by policy by D . O . D . 

362
00:15:29,218 --> 00:15:32,810
Directive . Uh We only will use burn 

363
00:15:32,810 --> 00:15:35,210
pits when it's an opera military , 

364
00:15:35,220 --> 00:15:37,840
operational necessity , everything 

365
00:15:37,850 --> 00:15:41,460
everything else the cocom the way 

366
00:15:41,940 --> 00:15:45,500
he or she manages that waste Um 

367
00:15:45,510 --> 00:15:49,330
will not be managed by open burn 

368
00:15:49,330 --> 00:15:51,386
pits . Have they determined that all 

369
00:15:51,386 --> 00:15:53,386
past burn pits in the last 20 years 

370
00:15:53,386 --> 00:15:57,240
were operationally necessary . Can you 

371
00:15:57,240 --> 00:15:59,073
repeat that question ? Have they 

372
00:15:59,073 --> 00:16:01,330
already determined that the hundreds of 

373
00:16:01,330 --> 00:16:03,386
burn pits that were used in the past 

374
00:16:03,386 --> 00:16:05,330
were all operationally necessary ? 

375
00:16:06,840 --> 00:16:10,840
Um Burn pits 

376
00:16:10,840 --> 00:16:14,560
that were used in the past were used 

377
00:16:15,040 --> 00:16:17,910
um Because when you establish a base 

378
00:16:17,910 --> 00:16:21,760
camp in an immature theater and 

379
00:16:22,240 --> 00:16:25,340
each Service member in a 

380
00:16:25,350 --> 00:16:29,230
deployed forces generating £10 

381
00:16:29,230 --> 00:16:32,160
or more of waste every day . And you 

382
00:16:32,160 --> 00:16:35,960
have 300-3000 . That's a lot of daily 

383
00:16:35,960 --> 00:16:38,650
waste . And we have to manage it 

384
00:16:39,240 --> 00:16:42,360
somehow and then an immature theater 

385
00:16:42,940 --> 00:16:46,140
before you can install incinerators or 

386
00:16:46,140 --> 00:16:49,560
contract to have it removed . 

387
00:16:50,340 --> 00:16:53,210
Burn pits were used , understood . Um 

388
00:16:53,210 --> 00:16:55,440
And then my final question which I 

389
00:16:55,440 --> 00:16:57,384
think you answered but what is the 

390
00:16:57,384 --> 00:16:59,607
process that is currently being used by 

391
00:16:59,607 --> 00:17:01,662
D . D . D . O . D . And each of your 

392
00:17:01,662 --> 00:17:03,884
services to determine whether a service 

393
00:17:03,884 --> 00:17:05,940
member returning from deployment has 

394
00:17:05,940 --> 00:17:08,051
been exposed to toxic fumes from burn 

395
00:17:08,051 --> 00:17:10,218
pits during his deployment and how and 

396
00:17:10,218 --> 00:17:12,384
where is that information recorded and 

397
00:17:12,384 --> 00:17:13,996
who has given access to that 

398
00:17:13,996 --> 00:17:16,218
information ? Is it shared with the V . 

399
00:17:16,218 --> 00:17:15,390
A . And I think you answered that 

400
00:17:15,390 --> 00:17:17,501
question in the beginning . Could you 

401
00:17:17,501 --> 00:17:19,970
just restate the answer ? Yeah . Um So 

402
00:17:19,980 --> 00:17:22,320
there there are a number of ways that 

403
00:17:22,320 --> 00:17:25,100
it's captured there . We have a pre 

404
00:17:25,100 --> 00:17:27,370
deployment assessment and a post 

405
00:17:27,380 --> 00:17:31,330
deployment assessment and that includes 

406
00:17:31,330 --> 00:17:34,780
questions on airborne hazards , 

407
00:17:34,790 --> 00:17:38,320
location exposure . Um And in addition 

408
00:17:38,320 --> 00:17:41,930
we have the separation assessment which 

409
00:17:41,930 --> 00:17:44,670
also includes similar questions on 

410
00:17:45,040 --> 00:17:47,010
health hazards and airborne 

411
00:17:47,010 --> 00:17:50,840
contamination and and location and 

412
00:17:50,850 --> 00:17:54,850
that is the separation assessment is 

413
00:17:54,860 --> 00:17:57,800
sent to the V . A . With the service 

414
00:17:57,800 --> 00:18:00,050
member and in addition all of that is 

415
00:18:00,060 --> 00:18:03,440
all of that is captured and 

416
00:18:03,440 --> 00:18:06,970
databases that is captured Under 

417
00:18:06,980 --> 00:18:09,300
island . And you believe that this data 

418
00:18:09,300 --> 00:18:11,300
has been being captured to at least 

419
00:18:11,300 --> 00:18:15,190
since 1999 . Mm hmm . Uh , 

420
00:18:15,200 --> 00:18:17,770
where the the airborne monitoring that 

421
00:18:17,770 --> 00:18:20,930
I'm talking about that we did um at 

422
00:18:20,930 --> 00:18:23,450
camp on steel and other areas of of 

423
00:18:23,450 --> 00:18:26,270
Kosovo were were stationary air 

424
00:18:26,270 --> 00:18:29,930
monitoring air monitors . We didn't 

425
00:18:29,930 --> 00:18:33,150
have the the current systems and 

426
00:18:33,150 --> 00:18:36,550
databases that we have today . I mean 

427
00:18:36,550 --> 00:18:38,910
we were writing it down on paper and 

428
00:18:38,920 --> 00:18:42,540
pencil the data back back then . Now 

429
00:18:42,540 --> 00:18:46,350
it's all captured electronically . So 

430
00:18:46,840 --> 00:18:50,360
can you provide for the committee What 

431
00:18:50,360 --> 00:18:54,060
years you have environmental data for 

432
00:18:54,070 --> 00:18:56,220
air quality in different deployments 

433
00:18:56,230 --> 00:18:58,341
around the globe . Sure . Of course . 

434
00:18:58,341 --> 00:19:00,508
Thank you . And it will go back before 

435
00:19:00,508 --> 00:19:03,540
1999 . It would . Okay . So that's I 

436
00:19:03,540 --> 00:19:06,080
mean we were doing the first gulf war 

437
00:19:06,090 --> 00:19:08,257
so we can get that information . So if 

438
00:19:08,257 --> 00:19:10,312
we wanted to know air quality at K . 

439
00:19:10,312 --> 00:19:12,860
Two we could get air quality from K two . 

440
00:19:16,140 --> 00:19:18,460
Uh , if if I can get air quality at K . 

441
00:19:18,460 --> 00:19:20,571
Two , I should be able to . Okay . So 

442
00:19:20,571 --> 00:19:22,738
that's the kind of information we need 

443
00:19:22,738 --> 00:19:24,849
because we know where there were open 

444
00:19:24,849 --> 00:19:27,071
burn pits from testimony of our service 

445
00:19:27,071 --> 00:19:29,293
members . And if we can get air quality 

446
00:19:29,293 --> 00:19:31,404
from those locations it'll make their 

447
00:19:31,640 --> 00:19:34,520
ability to for the D . O . D . To fully 

448
00:19:34,520 --> 00:19:36,742
understand that exposure did take place 

449
00:19:36,742 --> 00:19:38,409
because we have that data . I 

450
00:19:38,409 --> 00:19:39,687
understand . Thank you 

451
00:19:42,140 --> 00:19:44,640
Thank you chairman . Um thank you all 

452
00:19:44,640 --> 00:19:46,696
for being here . I wanted to go back 

453
00:19:46,696 --> 00:19:49,700
you were saying in 1999 I'm sure that 

454
00:19:49,700 --> 00:19:52,020
sensors have changed dramatically since 

455
00:19:52,020 --> 00:19:55,930
then . So give me an idea uh but now 

456
00:19:55,930 --> 00:19:58,270
about the training for preventative 

457
00:19:58,270 --> 00:20:01,030
medicine personnel about the nature of 

458
00:20:01,030 --> 00:20:02,863
the sensors whether or not we're 

459
00:20:02,863 --> 00:20:04,919
considering , I know these are areas 

460
00:20:04,919 --> 00:20:08,900
sensors probably but uh what's the 

461
00:20:08,900 --> 00:20:11,100
state of the art are are the state of 

462
00:20:11,100 --> 00:20:13,480
thinking in the D . O . D . For uh 

463
00:20:13,490 --> 00:20:15,379
wearable sensors , those sorts of 

464
00:20:15,379 --> 00:20:17,546
things so that we can track it down to 

465
00:20:17,546 --> 00:20:19,212
the potential exposures of an 

466
00:20:19,212 --> 00:20:22,200
individual in a situation . Thank you 

467
00:20:22,200 --> 00:20:24,910
senator . I'll start that answer off 

468
00:20:24,920 --> 00:20:26,809
and then I'm going to defer to my 

469
00:20:26,809 --> 00:20:28,809
colleagues to add a little bit more 

470
00:20:28,809 --> 00:20:31,390
detail from there perspective we're 

471
00:20:31,390 --> 00:20:35,280
very interested in in wearables . The 

472
00:20:35,280 --> 00:20:38,030
reason is because our emphasis our 

473
00:20:38,030 --> 00:20:41,010
focus really needs to be on individual 

474
00:20:41,010 --> 00:20:43,232
exposure , monitoring the things that I 

475
00:20:43,232 --> 00:20:45,440
was talking about before . The data 

476
00:20:45,440 --> 00:20:47,340
that we're capturing out of the 

477
00:20:47,340 --> 00:20:49,950
environment macro level . There you go . 

478
00:20:50,070 --> 00:20:52,126
And so you know you're going to have 

479
00:20:52,126 --> 00:20:54,290
you know 100 or 30 or or more 

480
00:20:54,290 --> 00:20:58,060
individuals um and and that and 

481
00:20:58,060 --> 00:21:01,270
that that data it's very difficult to 

482
00:21:01,270 --> 00:21:04,280
pinpoint exactly what an individual was 

483
00:21:04,280 --> 00:21:06,710
exposed to . And you know there's kind 

484
00:21:06,710 --> 00:21:09,240
of an old saying and in science at all 

485
00:21:09,250 --> 00:21:12,630
it all it all matters to dose response . 

486
00:21:12,630 --> 00:21:14,852
And and if we can't figure out what the 

487
00:21:14,852 --> 00:21:17,420
dose of the exposure was and what they 

488
00:21:17,420 --> 00:21:20,850
were exposed to ? That's very difficult 

489
00:21:20,860 --> 00:21:24,360
to you know , capture their response . 

490
00:21:24,740 --> 00:21:27,810
Um I'll defer to my colleagues on their 

491
00:21:27,810 --> 00:21:29,977
preventive medicine units and how they 

492
00:21:29,977 --> 00:21:32,420
train and the and the technology that 

493
00:21:32,420 --> 00:21:34,850
they use over to you all , captain . 

494
00:21:36,340 --> 00:21:39,960
Thank you Senator . Um We a couple 

495
00:21:39,960 --> 00:21:42,127
different things from Navy medicine so 

496
00:21:42,127 --> 00:21:44,349
most uh we're very proud of our forward 

497
00:21:44,349 --> 00:21:46,516
deployed preventative medicine units . 

498
00:21:46,516 --> 00:21:48,627
Uh They are agile expeditionary teams 

499
00:21:48,627 --> 00:21:50,738
that have quite a robust capability . 

500
00:21:50,738 --> 00:21:52,738
So for example they've got portable 

501
00:21:52,738 --> 00:21:54,980
sampling devices that are now part of a 

502
00:21:54,980 --> 00:21:57,780
tri service standardized program . They 

503
00:21:57,780 --> 00:21:59,850
support all services . In fact there 

504
00:22:00,240 --> 00:22:02,240
they've been deployed with the army 

505
00:22:02,240 --> 00:22:04,184
mostly and including currently but 

506
00:22:04,184 --> 00:22:06,129
those devices can conduct a pretty 

507
00:22:06,129 --> 00:22:08,407
comprehensive evaluation of soil , air , 

508
00:22:08,407 --> 00:22:11,840
water , water vapor at an individual 

509
00:22:11,840 --> 00:22:14,550
portable level . Vice having a static 

510
00:22:14,550 --> 00:22:16,840
sensor . So that's a that's a robust 

511
00:22:16,840 --> 00:22:19,062
capability that's that's fairly cutting 

512
00:22:19,062 --> 00:22:22,820
edge um with regard to wearables . One 

513
00:22:22,820 --> 00:22:25,360
unique thing that the Navy medicine is 

514
00:22:25,360 --> 00:22:27,582
doing with research and development got 

515
00:22:27,582 --> 00:22:29,249
some very robust submarine uh 

516
00:22:29,249 --> 00:22:31,270
atmospheric monitoring . Uh quite a 

517
00:22:31,270 --> 00:22:34,170
robust and safe program . And R . And D . 

518
00:22:34,170 --> 00:22:36,220
Is looking at uh silicone bands 

519
00:22:36,220 --> 00:22:38,160
wearables so that you can get 

520
00:22:38,170 --> 00:22:41,480
individual level uh exposure data on a 

521
00:22:41,480 --> 00:22:43,900
submarine . In addition to that our 

522
00:22:43,900 --> 00:22:45,678
research labs in Dayton have an 

523
00:22:45,678 --> 00:22:47,789
environmental health directorate that 

524
00:22:47,789 --> 00:22:49,956
are looking at biomarkers and um other 

525
00:22:49,956 --> 00:22:51,900
correlates translating from animal 

526
00:22:51,900 --> 00:22:54,067
models that will help us in the future 

527
00:22:54,067 --> 00:22:55,844
Uh get down to individual level 

528
00:22:55,844 --> 00:22:57,678
exposure . Colonel , do you have 

529
00:22:57,678 --> 00:23:01,290
anything to add ? Thank you , 

530
00:23:01,290 --> 00:23:03,690
senator . So and and for the Department 

531
00:23:03,690 --> 00:23:05,634
of the Air Force is very similar . 

532
00:23:05,634 --> 00:23:07,746
We're looking into the wearables . We 

533
00:23:07,746 --> 00:23:09,746
haven't instituted them yet but but 

534
00:23:09,746 --> 00:23:13,060
there is there in development . Doctor 

535
00:23:13,060 --> 00:23:15,790
marisa Senator . Thank you for the 

536
00:23:15,790 --> 00:23:17,568
opportunity . Um myself like my 

537
00:23:17,568 --> 00:23:19,346
colleague . So we are also very 

538
00:23:19,346 --> 00:23:21,457
interested in wearable technology . I 

539
00:23:21,457 --> 00:23:23,679
think it's also important to underscore 

540
00:23:23,679 --> 00:23:25,568
that the Army preventive medicine 

541
00:23:25,568 --> 00:23:27,457
detachments are quite skilled and 

542
00:23:27,457 --> 00:23:29,290
equipped to conduct the ambiance 

543
00:23:29,290 --> 00:23:31,346
sampling that they do as part of the 

544
00:23:31,346 --> 00:23:33,457
missions when they're for deploy . Um 

545
00:23:33,457 --> 00:23:32,920
Certainly air quality is not the 

546
00:23:32,920 --> 00:23:35,730
exclusive issue of concern as well as 

547
00:23:35,740 --> 00:23:37,684
other environmental issues such as 

548
00:23:37,684 --> 00:23:40,140
vector borne diseases . Uh Pest control 

549
00:23:40,140 --> 00:23:42,970
management , um communicable diseases 

550
00:23:42,970 --> 00:23:45,026
and they are equipped and trained in 

551
00:23:45,026 --> 00:23:46,803
that respect with environmental 

552
00:23:46,803 --> 00:23:48,581
engineers , scientists and also 

553
00:23:48,581 --> 00:23:50,803
complementary clinical staff and public 

554
00:23:50,803 --> 00:23:53,070
health and preventive medicine um that 

555
00:23:53,070 --> 00:23:55,014
are able to provide adjunctive and 

556
00:23:55,014 --> 00:23:57,380
consultive support on site . Um and not 

557
00:23:57,380 --> 00:23:59,491
only within the P . M . Community but 

558
00:23:59,491 --> 00:24:01,269
also for all providers that are 

559
00:24:01,269 --> 00:24:03,960
downrange . And so um it's a it's a 

560
00:24:03,960 --> 00:24:05,682
pretty synchronized and robust 

561
00:24:05,682 --> 00:24:07,849
capability of the army provides Amanda 

562
00:24:07,849 --> 00:24:09,627
contingency operation to assess 

563
00:24:09,627 --> 00:24:12,020
exposures and respond to them . You 

564
00:24:12,020 --> 00:24:14,242
know , I I think one of the reasons why 

565
00:24:14,242 --> 00:24:16,600
we should focus so much on wearables is 

566
00:24:16,600 --> 00:24:19,040
we get an atomic view of exposures and 

567
00:24:19,040 --> 00:24:21,940
then hopefully as a part of the process 

568
00:24:21,950 --> 00:24:24,172
that's being captured in the electronic 

569
00:24:24,172 --> 00:24:26,394
health record of the individual service 

570
00:24:26,394 --> 00:24:28,617
member and ultimately being transferred 

571
00:24:28,617 --> 00:24:30,839
to the electronic health record for the 

572
00:24:30,839 --> 00:24:32,783
veteran . Now that we have a joint 

573
00:24:32,783 --> 00:24:34,894
office for the certner implementation 

574
00:24:34,894 --> 00:24:37,190
for the V . A . Electronic health 

575
00:24:37,190 --> 00:24:39,357
record . I think it's going to be very 

576
00:24:39,357 --> 00:24:41,690
important to have a seamless transition . 

577
00:24:41,690 --> 00:24:43,912
And then hopefully we get to a point if 

578
00:24:43,912 --> 00:24:46,023
you're able to capture enough data to 

579
00:24:46,023 --> 00:24:48,246
where we can apply predictive analytics 

580
00:24:48,246 --> 00:24:47,880
to maybe identify an exposure long 

581
00:24:47,880 --> 00:24:50,280
before any symptoms have manifested 

582
00:24:50,280 --> 00:24:52,336
themselves . Dr roger . Did you have 

583
00:24:52,336 --> 00:24:54,391
something to add ? Well I would also 

584
00:24:54,391 --> 00:24:56,970
add Senator in addition to wearables , 

585
00:24:56,970 --> 00:25:00,640
we need to understand um more about how 

586
00:25:00,640 --> 00:25:04,130
the how the individual responds to 

587
00:25:04,250 --> 00:25:07,440
environmental exposures . Um What what 

588
00:25:07,440 --> 00:25:10,770
risk do they bring ? Other background 

589
00:25:10,770 --> 00:25:14,460
lifestyle factors such as are you 

590
00:25:14,460 --> 00:25:17,670
smoking a pack a day before you deploy 

591
00:25:18,140 --> 00:25:21,170
other lifestyle factors or even what 

592
00:25:21,540 --> 00:25:24,710
what genetic background individuals 

593
00:25:24,710 --> 00:25:27,920
bring ? Um We need to understand those 

594
00:25:27,920 --> 00:25:30,142
because they're going to have an impact 

595
00:25:30,142 --> 00:25:32,170
in science isn't area but we're 

596
00:25:32,170 --> 00:25:35,350
pursuing it over . Thank you . Senator 

597
00:25:35,350 --> 00:25:38,810
Holly . Thank you . Senator . Tell us 

598
00:25:38,820 --> 00:25:40,931
um Doctor asked if I could just start 

599
00:25:40,931 --> 00:25:42,987
with you , you you testified in your 

600
00:25:42,987 --> 00:25:45,098
written testimony that since 2000 and 

601
00:25:45,098 --> 00:25:48,480
1/4 million . Now veterans as well as D . 

602
00:25:48,480 --> 00:25:50,369
O . D . Civilians and contractors 

603
00:25:50,369 --> 00:25:52,536
deployed to the Southwest ASIA theater 

604
00:25:52,536 --> 00:25:54,424
of operations . How many of these 

605
00:25:54,424 --> 00:25:56,591
individuals would have been exposed to 

606
00:25:56,591 --> 00:25:58,536
airborne hazards , including toxic 

607
00:25:58,536 --> 00:26:00,702
exposures from burn pits . Do you know 

608
00:26:00,702 --> 00:26:03,020
in that time frame ? Well I can't 

609
00:26:03,020 --> 00:26:05,270
imagine that um 

610
00:26:06,540 --> 00:26:10,310
that uh all of them 

611
00:26:10,310 --> 00:26:13,150
should have been exposed to some types 

612
00:26:13,150 --> 00:26:16,050
of airborne hazards . If they were 

613
00:26:16,050 --> 00:26:19,890
deployed in various base camps and 

614
00:26:19,900 --> 00:26:21,733
environments in Southwest Asia . 

615
00:26:21,733 --> 00:26:24,360
Because Southwest Asia , just the up 

616
00:26:24,840 --> 00:26:27,290
just the military operational 

617
00:26:27,290 --> 00:26:31,250
environment vehicles earn 

618
00:26:31,250 --> 00:26:34,890
pits , everything , everything 

619
00:26:34,890 --> 00:26:38,400
else to include sandstorms create a lot 

620
00:26:38,400 --> 00:26:41,360
of potential for airborne hazards . And 

621
00:26:41,940 --> 00:26:45,450
um if you're there you're exposed to it . 

622
00:26:46,540 --> 00:26:48,651
What what is D . O . D . S . Estimate 

623
00:26:48,651 --> 00:26:50,873
for the number of individuals who would 

624
00:26:50,873 --> 00:26:53,040
qualify for the presumption of service 

625
00:26:53,040 --> 00:26:54,929
related connection given how many 

626
00:26:54,929 --> 00:26:57,096
individuals were exposed and so on . I 

627
00:26:57,096 --> 00:26:59,207
gotta take that for the record . I'll 

628
00:26:59,207 --> 00:27:01,262
get I'll get you as much detail as I 

629
00:27:01,262 --> 00:27:03,318
can but I can't give that to you off 

630
00:27:03,318 --> 00:27:05,207
the top of my head senator . Well 

631
00:27:05,207 --> 00:27:07,318
that's fine I'll uh we'll take it for 

632
00:27:07,318 --> 00:27:09,429
the record and I look forward to your 

633
00:27:09,429 --> 00:27:11,651
answer . What was what was the practice 

634
00:27:11,651 --> 00:27:13,818
of burn pits and other theaters during 

635
00:27:13,818 --> 00:27:16,290
this period of Of time . From 2001 

636
00:27:16,300 --> 00:27:18,550
Forward . Do you know Tirosh . Besides 

637
00:27:18,550 --> 00:27:21,960
that is Southwest Asia . What other 

638
00:27:21,960 --> 00:27:25,170
burn pits and other combatant commands ? 

639
00:27:26,740 --> 00:27:30,700
Um I'll take it for the record . 

640
00:27:30,710 --> 00:27:32,766
Most of them should have been in the 

641
00:27:32,766 --> 00:27:36,460
centcom . Ao are there . Okay . And 

642
00:27:37,840 --> 00:27:39,951
well okay so if they're in the senate 

643
00:27:39,951 --> 00:27:42,290
committee or then they're in this same 

644
00:27:42,290 --> 00:27:44,346
region that we've been talking about 

645
00:27:44,346 --> 00:27:47,880
roughly um Tell me about just the 

646
00:27:47,890 --> 00:27:50,410
docs collection of this of this data . 

647
00:27:50,420 --> 00:27:54,060
I mean what we're dealing with 

648
00:27:54,070 --> 00:27:56,760
service members exposure to toxins , 

649
00:27:56,760 --> 00:27:59,400
burn pit toxins , other airborne's it 

650
00:27:59,400 --> 00:28:02,160
seems like we have very limited data 

651
00:28:02,170 --> 00:28:04,960
for a lot of this . Why is that why why 

652
00:28:04,970 --> 00:28:07,430
is it the D . O . D . Is not collected 

653
00:28:07,440 --> 00:28:09,662
this kind of data for so long . Can you 

654
00:28:09,662 --> 00:28:11,662
give me any insight ? I think we've 

655
00:28:11,662 --> 00:28:15,460
always improved um the the extent of 

656
00:28:15,460 --> 00:28:18,130
the data and the technologies that we 

657
00:28:18,140 --> 00:28:21,300
that we collect the data with and we 

658
00:28:21,300 --> 00:28:24,160
continue to improve . I mean we collect 

659
00:28:24,170 --> 00:28:27,070
a lot of environmental health 

660
00:28:27,080 --> 00:28:30,900
assessment data but you know a number 

661
00:28:30,900 --> 00:28:34,120
of compounds in the number of airborne 

662
00:28:34,120 --> 00:28:37,930
compounds particular matter compounds 

663
00:28:37,930 --> 00:28:40,270
that are in the motor pool over there . 

664
00:28:40,640 --> 00:28:43,960
Um The compounds and um 

665
00:28:44,440 --> 00:28:46,218
you know in the soil that could 

666
00:28:46,218 --> 00:28:49,090
aerosolize as a result of operations . 

667
00:28:49,100 --> 00:28:52,520
A lot of that is is um is 

668
00:28:52,520 --> 00:28:56,200
collected and it goes into 

669
00:28:56,840 --> 00:28:59,890
a database that we call doors and doors 

670
00:28:59,890 --> 00:29:02,690
is a large database that can then feed 

671
00:29:02,690 --> 00:29:05,140
into Eyler which is what I was talking 

672
00:29:05,140 --> 00:29:07,160
about which is an individual 

673
00:29:07,540 --> 00:29:10,600
longitudinal exposure record that 

674
00:29:10,610 --> 00:29:13,300
pinpoints the location of the service 

675
00:29:13,300 --> 00:29:15,490
member with all of that environmental 

676
00:29:15,490 --> 00:29:19,350
data and therefore the 

677
00:29:19,360 --> 00:29:23,250
the the healthcare provider can take a 

678
00:29:23,250 --> 00:29:26,270
look and get kind of a summary of 

679
00:29:27,240 --> 00:29:30,240
where the service member was what the 

680
00:29:30,240 --> 00:29:33,060
environmental hazards were in that in 

681
00:29:33,060 --> 00:29:36,460
that area and can best you know 

682
00:29:36,940 --> 00:29:40,360
form a treatment regime for that 

683
00:29:40,940 --> 00:29:43,780
for that service member . What about 

684
00:29:43,790 --> 00:29:45,623
data available for assessing the 

685
00:29:45,623 --> 00:29:48,120
linkages between exposure that we've 

686
00:29:48,120 --> 00:29:50,520
been talking about to airborne toxins 

687
00:29:50,530 --> 00:29:52,641
including particularly from burn pits 

688
00:29:52,641 --> 00:29:54,641
and certain kinds of of illnesses . 

689
00:29:54,641 --> 00:29:56,700
What has D . O . D . Been doing to 

690
00:29:56,700 --> 00:29:58,811
improve data collection on that score 

691
00:29:59,440 --> 00:30:02,770
and data analysis well um 

692
00:30:03,640 --> 00:30:06,940
so it's a it's a part of the of the 

693
00:30:06,940 --> 00:30:08,990
data that we already collect by 

694
00:30:08,990 --> 00:30:11,440
preventive medicine units in store in 

695
00:30:11,440 --> 00:30:14,450
our in our in our databases . But 

696
00:30:14,450 --> 00:30:16,850
linking those exposures 

697
00:30:17,840 --> 00:30:21,560
two illnesses um 

698
00:30:22,240 --> 00:30:25,140
has been somewhat challenging a couple 

699
00:30:25,140 --> 00:30:27,196
of years ago the National Academy of 

700
00:30:27,196 --> 00:30:30,120
Sciences um said that there is 

701
00:30:30,120 --> 00:30:33,560
consistent data um 

702
00:30:33,570 --> 00:30:37,510
from from exposures in 

703
00:30:37,510 --> 00:30:41,040
Southwest AsIA to our deployed force 

704
00:30:41,640 --> 00:30:45,270
and illnesses such as persistent cough 

705
00:30:46,040 --> 00:30:49,360
um Asma and a few other 

706
00:30:50,260 --> 00:30:52,860
respiratory um 

707
00:30:53,290 --> 00:30:57,020
disorders . More data is needed 

708
00:30:57,030 --> 00:31:00,360
and more more specific data 

709
00:31:00,940 --> 00:31:03,760
linking individuals to certain 

710
00:31:04,140 --> 00:31:07,170
airborne hazards and their health 

711
00:31:07,170 --> 00:31:10,110
outcomes is needed to be able to expand 

712
00:31:10,110 --> 00:31:14,070
that list . Um I'll circle back to you 

713
00:31:14,070 --> 00:31:16,070
on the questions for the record . I 

714
00:31:16,070 --> 00:31:18,014
probably have a few more as well . 

715
00:31:18,014 --> 00:31:20,014
Thank you . Mr Chairman . Um Just a 

716
00:31:20,014 --> 00:31:21,737
couple of follow ups . Senator 

717
00:31:21,737 --> 00:31:23,514
Gillibrand went to vote . She's 

718
00:31:23,514 --> 00:31:23,450
probably waiting on the second boat to 

719
00:31:23,450 --> 00:31:26,580
be called . So I'm kind of curious 

720
00:31:26,580 --> 00:31:29,150
about when Eyler will be fully 

721
00:31:29,160 --> 00:31:32,180
interoperable with D . O . D . S . 

722
00:31:32,190 --> 00:31:35,160
Electronic health record and the via 

723
00:31:35,160 --> 00:31:37,271
electronic health record . What's the 

724
00:31:37,271 --> 00:31:40,520
timeline ? Yeah the timeline for full 

725
00:31:40,660 --> 00:31:42,630
capability is 

726
00:31:44,040 --> 00:31:47,690
2023 but it is capable now 

727
00:31:47,700 --> 00:31:50,190
that's with a little bit less limited 

728
00:31:50,200 --> 00:31:52,367
with the D . O . D . Electronic health 

729
00:31:52,367 --> 00:31:54,311
record because I guess the V . A . 

730
00:31:54,311 --> 00:31:56,144
Electronic health record is in a 

731
00:31:56,144 --> 00:31:58,089
multiyear implementation . So that 

732
00:31:58,089 --> 00:32:00,033
wouldn't be probably would have to 

733
00:32:00,033 --> 00:32:02,144
track along with their ultimate build 

734
00:32:02,144 --> 00:32:05,550
out . Uh That's my understanding . Tell 

735
00:32:05,550 --> 00:32:07,439
me a little bit about D . O . D . 

736
00:32:07,439 --> 00:32:11,330
Funded research on taking the 

737
00:32:11,330 --> 00:32:13,052
information that we have about 

738
00:32:13,052 --> 00:32:16,770
potentially toxic exposures and um 

739
00:32:17,740 --> 00:32:19,851
making certain Presumptions about how 

740
00:32:19,851 --> 00:32:21,962
that exposure could have caused a bad 

741
00:32:21,962 --> 00:32:24,200
outcome for a service member . Sure . 

742
00:32:24,210 --> 00:32:27,550
So called Presumptions . Sure . So um 

743
00:32:28,240 --> 00:32:30,930
with regard to human studies , most of 

744
00:32:30,930 --> 00:32:34,230
the human studies human research that 

745
00:32:34,230 --> 00:32:37,020
we sponsor and continue to sponsor 

746
00:32:37,130 --> 00:32:40,920
really compares a group of 

747
00:32:40,930 --> 00:32:44,910
dip lawyers to a group of a control 

748
00:32:44,910 --> 00:32:47,650
group of non deploy ear's to take a 

749
00:32:47,650 --> 00:32:51,600
look at location environmental health 

750
00:32:51,600 --> 00:32:54,440
assessments , um what were the threats 

751
00:32:54,440 --> 00:32:56,650
over there and then and then look at 

752
00:32:56,650 --> 00:32:58,940
the differences in terms of the 

753
00:32:58,940 --> 00:33:01,260
incidence of health outcomes between 

754
00:33:01,740 --> 00:33:04,430
the deployed force in that area and the 

755
00:33:04,430 --> 00:33:07,560
control that were non dip lawyers . 

756
00:33:08,140 --> 00:33:11,520
Um In addition to that , we also have 

757
00:33:11,530 --> 00:33:15,070
experiments um We have animal 

758
00:33:15,070 --> 00:33:18,670
experiments at the Air Force at Wright 

759
00:33:18,670 --> 00:33:22,490
Patt up at the 7/11 which are looking 

760
00:33:22,500 --> 00:33:26,460
at um exposure to 

761
00:33:26,470 --> 00:33:29,770
experimental animals um of 

762
00:33:29,780 --> 00:33:33,050
different airborne hazards to 

763
00:33:33,050 --> 00:33:35,840
include compounds that you would see in 

764
00:33:35,840 --> 00:33:39,330
burn pits versus and 

765
00:33:39,330 --> 00:33:43,040
also airborne sand and dust . You 

766
00:33:43,040 --> 00:33:45,670
would you would see in that deployed 

767
00:33:45,670 --> 00:33:47,781
environment and looking at the health 

768
00:33:48,040 --> 00:33:50,870
health effects , health outcomes in 

769
00:33:50,870 --> 00:33:53,320
experimental animals . Those are just 

770
00:33:53,340 --> 00:33:56,830
those are just a few . How my if my 

771
00:33:56,830 --> 00:34:00,310
colleagues want to add 

772
00:34:00,310 --> 00:34:03,850
anything , please do captain . 

773
00:34:05,540 --> 00:34:09,490
Thank you senator . Um I'm aware 

774
00:34:09,490 --> 00:34:13,260
of uh a lot of work by the Navy Medical 

775
00:34:13,260 --> 00:34:15,880
Research Command in the Naval Health 

776
00:34:15,890 --> 00:34:18,160
Research Center which is based in SAn 

777
00:34:18,160 --> 00:34:20,990
Diego . They've got uh in addition to 

778
00:34:21,000 --> 00:34:24,180
uh collaborating with the V . A . On 

779
00:34:24,180 --> 00:34:25,847
these studies , they've got a 

780
00:34:25,847 --> 00:34:27,958
millennium cohort which is a powerful 

781
00:34:27,958 --> 00:34:29,870
source of of an extremely large 

782
00:34:29,870 --> 00:34:31,814
population that's allowing them to 

783
00:34:31,814 --> 00:34:34,140
explore all of these questions . Um I 

784
00:34:34,140 --> 00:34:36,084
will defer to my colleagues before 

785
00:34:36,084 --> 00:34:38,362
getting into specifics , but thank you . 

786
00:34:38,840 --> 00:34:41,062
Yeah , we already , thank you senator . 

787
00:34:41,540 --> 00:34:43,707
We already know that there is a lot of 

788
00:34:43,707 --> 00:34:45,930
medical symptoms and diseases that are 

789
00:34:45,940 --> 00:34:49,020
associated with open burn pits and 

790
00:34:49,030 --> 00:34:51,930
other airborne toxins . But it's it's 

791
00:34:51,930 --> 00:34:53,874
difficult to find a direct link to 

792
00:34:53,874 --> 00:34:56,041
those at this time . But there is many 

793
00:34:56,041 --> 00:34:57,986
studies that are underway that are 

794
00:34:57,986 --> 00:34:59,708
looking into that . Uh and and 

795
00:34:59,708 --> 00:35:01,819
hopefully in the future we'll be able 

796
00:35:01,819 --> 00:35:03,874
to link that . I think the important 

797
00:35:03,874 --> 00:35:03,800
thing with the Isler is the either 

798
00:35:03,800 --> 00:35:06,250
captures the data . It links it to the 

799
00:35:06,250 --> 00:35:08,820
individual . It also captures data from 

800
00:35:08,820 --> 00:35:10,653
when the individual returns from 

801
00:35:10,653 --> 00:35:12,320
deployment . And I asked them 

802
00:35:12,320 --> 00:35:14,487
specifically if they have any symptoms 

803
00:35:14,487 --> 00:35:16,431
or have any concerns with airborne 

804
00:35:16,431 --> 00:35:18,542
hazards or chemicals . And so if they 

805
00:35:18,542 --> 00:35:20,376
answer that to the affirmative , 

806
00:35:20,376 --> 00:35:22,653
there's always a provider that's gonna , 

807
00:35:22,653 --> 00:35:24,876
that's gonna talk to him one on one and 

808
00:35:24,876 --> 00:35:27,042
address that with him . They also have 

809
00:35:27,042 --> 00:35:29,042
a post deployment health assessment 

810
00:35:29,042 --> 00:35:31,209
that occurs 90 280 days after they get 

811
00:35:31,209 --> 00:35:33,431
back . And it's the same questions they 

812
00:35:33,431 --> 00:35:35,542
asked them . Do you have any symptoms 

813
00:35:35,542 --> 00:35:37,598
or any uh any concerns you have with 

814
00:35:37,598 --> 00:35:39,709
airborne hazards and chemicals And uh 

815
00:35:39,709 --> 00:35:41,876
and once again , if those are answered 

816
00:35:41,876 --> 00:35:44,042
in the affirmative , then the provider 

817
00:35:44,042 --> 00:35:43,560
gets with them and they talk to them 

818
00:35:44,240 --> 00:35:46,296
again during the preventative health 

819
00:35:46,296 --> 00:35:48,462
assessment that specifically goes into 

820
00:35:48,462 --> 00:35:50,462
those questions again . And this is 

821
00:35:50,462 --> 00:35:52,407
something that every member of the 

822
00:35:52,407 --> 00:35:54,629
Department of Air Force gets annually . 

823
00:35:54,629 --> 00:35:56,629
They asked the same questions . And 

824
00:35:56,629 --> 00:35:58,629
they also go into the open burn pit 

825
00:35:58,629 --> 00:36:00,740
registry . They encourage all members 

826
00:36:00,740 --> 00:36:02,962
to register for that if they've been in 

827
00:36:02,962 --> 00:36:02,910
a deployed area with an open burn pit , 

828
00:36:02,920 --> 00:36:05,142
even if they don't have any symptoms or 

829
00:36:05,142 --> 00:36:07,364
any concerns there , they're encouraged 

830
00:36:07,364 --> 00:36:09,364
to go ahead and uh and register for 

831
00:36:09,364 --> 00:36:11,309
that . And uh and once again , the 

832
00:36:11,309 --> 00:36:13,476
provider will reach back and talk with 

833
00:36:13,476 --> 00:36:15,364
them and go over any questions or 

834
00:36:15,364 --> 00:36:17,698
concerns that they might have DR Marcia , 

835
00:36:18,630 --> 00:36:20,408
thank you Senator , um , in our 

836
00:36:20,408 --> 00:36:22,574
organization of the Army Public Health 

837
00:36:22,574 --> 00:36:24,630
Center . We we've engaged in several 

838
00:36:24,630 --> 00:36:26,686
epidemiological studies and in those 

839
00:36:26,686 --> 00:36:28,908
studies , we essentially use deployment 

840
00:36:28,908 --> 00:36:31,074
history as a proxy for exposures . And 

841
00:36:31,074 --> 00:36:32,940
so of course that can include um 

842
00:36:32,950 --> 00:36:35,120
exposures to burn pits , but also to 

843
00:36:35,120 --> 00:36:37,287
the poor air quality conditions within 

844
00:36:37,287 --> 00:36:39,730
within the area of operations . And we 

845
00:36:39,730 --> 00:36:41,897
also take that information and we look 

846
00:36:41,897 --> 00:36:43,563
at the health status of those 

847
00:36:43,563 --> 00:36:45,619
individuals before they deployed and 

848
00:36:45,619 --> 00:36:47,174
after they deployed to make 

849
00:36:47,174 --> 00:36:49,397
determinations about whether or not the 

850
00:36:49,397 --> 00:36:51,452
association's existed for particular 

851
00:36:51,452 --> 00:36:54,520
respiratory disorders of interest . Um 

852
00:36:54,520 --> 00:36:56,980
What what we have found is that these 

853
00:36:56,990 --> 00:36:59,157
epidemiological studies are not always 

854
00:36:59,157 --> 00:37:01,250
very conclusive and and and a lot of 

855
00:37:01,250 --> 00:37:03,417
that has to do with limitations of the 

856
00:37:03,417 --> 00:37:05,910
study because we don't necessarily have 

857
00:37:05,920 --> 00:37:08,720
individualized exposure information 

858
00:37:08,720 --> 00:37:12,340
tied to two Um P two individuals and 

859
00:37:12,340 --> 00:37:14,173
their health outcomes . That's a 

860
00:37:14,173 --> 00:37:16,284
significant limitations . But what we 

861
00:37:16,284 --> 00:37:18,062
do have the strongest strongest 

862
00:37:18,062 --> 00:37:20,284
evidence to suggest is that respiratory 

863
00:37:20,284 --> 00:37:23,600
symptoms um are are present in many 

864
00:37:23,600 --> 00:37:26,540
deploy ear's um into into this income 

865
00:37:26,540 --> 00:37:28,890
area of operations as a as a function 

866
00:37:28,890 --> 00:37:30,834
of the air quality issues that are 

867
00:37:30,834 --> 00:37:32,779
there . So those symptoms are like 

868
00:37:32,779 --> 00:37:34,834
shortness of breath , cough , phlegm 

869
00:37:34,834 --> 00:37:38,620
production dec criminals in their their 

870
00:37:38,620 --> 00:37:40,740
ability to successfully passed their 

871
00:37:40,750 --> 00:37:42,930
physical performance tests and things 

872
00:37:42,930 --> 00:37:44,986
of that nature . And so we have that 

873
00:37:44,986 --> 00:37:46,990
information . Um Other studies have 

874
00:37:46,990 --> 00:37:49,101
been conducted . I've been looking at 

875
00:37:49,101 --> 00:37:51,101
deploy as themselves and looking at 

876
00:37:51,101 --> 00:37:53,268
them prospectively , how they how they 

877
00:37:53,268 --> 00:37:55,320
have been managed um clinically and 

878
00:37:55,320 --> 00:37:57,570
what conditions they have suffered as a 

879
00:37:57,570 --> 00:37:59,348
consequence of the deployment , 

880
00:37:59,348 --> 00:38:01,348
particularly looking at respiratory 

881
00:38:01,348 --> 00:38:03,348
conditions . A small study that was 

882
00:38:03,348 --> 00:38:05,403
conducted looked at those particular 

883
00:38:05,403 --> 00:38:07,459
deploys and determined about half of 

884
00:38:07,459 --> 00:38:07,010
those individuals didn't have 

885
00:38:07,010 --> 00:38:09,010
necessarily diagnosable respiratory 

886
00:38:09,010 --> 00:38:11,066
conditions per se , despite the fact 

887
00:38:11,066 --> 00:38:13,177
that they had symptoms that they that 

888
00:38:13,177 --> 00:38:15,288
they complained about . But the other 

889
00:38:15,288 --> 00:38:17,510
half seemed to have symptoms consistent 

890
00:38:17,510 --> 00:38:19,677
with asthma and hyper hyper reactivity 

891
00:38:19,677 --> 00:38:21,843
of their airway and such and so um The 

892
00:38:21,843 --> 00:38:23,899
bottom line is there's been a lot of 

893
00:38:23,899 --> 00:38:26,290
study studying occurring about dip 

894
00:38:26,290 --> 00:38:29,630
lawyers and their respiratory health 

895
00:38:29,640 --> 00:38:31,640
and the potential associations that 

896
00:38:31,640 --> 00:38:33,590
exist with the deployment . Um But 

897
00:38:33,590 --> 00:38:35,701
based on limitations on exposure data 

898
00:38:35,701 --> 00:38:37,534
is very difficult to make strong 

899
00:38:37,534 --> 00:38:39,370
conclusions about the source of 

900
00:38:39,370 --> 00:38:41,426
exposure and those health outcomes . 

901
00:38:41,820 --> 00:38:42,820
Thank you . 

902
00:38:47,720 --> 00:38:49,942
The department's prepared statement for 

903
00:38:49,942 --> 00:38:52,109
this hearing states that peer reviewed 

904
00:38:52,109 --> 00:38:53,998
published research documents that 

905
00:38:53,998 --> 00:38:56,220
military personnel deployed to Iraq and 

906
00:38:56,220 --> 00:38:58,164
Afghanistan appeared to experience 

907
00:38:58,164 --> 00:39:00,164
elevated right rates of acute upper 

908
00:39:00,164 --> 00:39:02,331
respiratory symptoms during deployment 

909
00:39:02,331 --> 00:39:04,331
and may be at greater risk for post 

910
00:39:04,331 --> 00:39:06,442
deployment , respiratory symptoms and 

911
00:39:06,442 --> 00:39:08,664
respiratory illnesses . Doctor marisa , 

912
00:39:08,664 --> 00:39:10,664
Doctor Newell and dr Feldman please 

913
00:39:10,664 --> 00:39:12,609
describe what your service does to 

914
00:39:12,609 --> 00:39:14,720
ensure that service members concerned 

915
00:39:14,720 --> 00:39:16,609
about potential health effects of 

916
00:39:16,609 --> 00:39:18,664
exposure to airborne hazards receive 

917
00:39:18,664 --> 00:39:20,720
appropriate healthcare . And is this 

918
00:39:20,720 --> 00:39:20,500
care documented in their health records . 

919
00:39:20,500 --> 00:39:22,667
And will this information be available 

920
00:39:22,667 --> 00:39:24,833
to the V . A . When the service member 

921
00:39:24,833 --> 00:39:26,667
leaves service and receives care 

922
00:39:26,667 --> 00:39:30,010
through the V . A . Senator . Thank you 

923
00:39:30,010 --> 00:39:31,899
for that question . Um A walk you 

924
00:39:31,899 --> 00:39:34,080
through essentially a process that we 

925
00:39:34,080 --> 00:39:37,620
undertake um First um when individuals 

926
00:39:37,620 --> 00:39:39,676
are in deployed environment and they 

927
00:39:39,676 --> 00:39:41,620
are suffering with any respiratory 

928
00:39:41,620 --> 00:39:43,842
illness . Rather let let me take a step 

929
00:39:43,842 --> 00:39:45,953
back any illness or any symptoms . Um 

930
00:39:45,953 --> 00:39:48,090
We have medical personnel , we have 

931
00:39:48,100 --> 00:39:50,520
medical centers that are deployed or M . 

932
00:39:50,520 --> 00:39:52,687
T . F . S . That are deployed um there 

933
00:39:52,687 --> 00:39:54,798
with appropriate personnel to respond 

934
00:39:54,798 --> 00:39:56,464
to those concerns . Those get 

935
00:39:56,464 --> 00:39:58,687
documented and are available throughout 

936
00:39:58,687 --> 00:40:00,909
the course of that that service members 

937
00:40:00,909 --> 00:40:02,798
service treatment record um to be 

938
00:40:02,798 --> 00:40:04,742
looked at perspectively when these 

939
00:40:04,742 --> 00:40:06,853
individuals redeploy , they come back 

940
00:40:06,853 --> 00:40:08,909
home um They undergo post deployment 

941
00:40:08,909 --> 00:40:10,576
health assessment and there's 

942
00:40:10,576 --> 00:40:12,687
essentially two parts . That one is a 

943
00:40:12,687 --> 00:40:12,110
screening questionnaire in which of 

944
00:40:12,110 --> 00:40:14,680
these individuals self report concerns 

945
00:40:14,680 --> 00:40:16,847
about their health , their respiratory 

946
00:40:16,847 --> 00:40:18,958
symptoms and another organ associated 

947
00:40:18,958 --> 00:40:21,069
symptom Atala ji of interest . And we 

948
00:40:21,069 --> 00:40:23,530
also ask about their concerns about 

949
00:40:23,530 --> 00:40:25,530
environmental exposures . The whole 

950
00:40:25,530 --> 00:40:27,586
scope of exposure is not necessarily 

951
00:40:27,586 --> 00:40:29,697
airborne but but chemical and so on . 

952
00:40:29,910 --> 00:40:31,688
Um Once they complete that self 

953
00:40:31,688 --> 00:40:34,020
assessment , these individuals then are 

954
00:40:34,030 --> 00:40:36,030
evaluated by a provider and they're 

955
00:40:36,030 --> 00:40:38,252
given that option for a focused medical 

956
00:40:38,252 --> 00:40:40,363
evaluation based on any concerns that 

957
00:40:40,363 --> 00:40:42,419
they have advocated for on that self 

958
00:40:42,419 --> 00:40:45,440
assessment routinely we conduct 

959
00:40:45,450 --> 00:40:48,480
periodic health assessments . Um There 

960
00:40:48,490 --> 00:40:52,080
this has a couple of a couple of 

961
00:40:52,090 --> 00:40:55,410
purposes . The first um is to assure 

962
00:40:55,410 --> 00:40:57,830
that individuals are assessed annually 

963
00:40:57,840 --> 00:40:59,729
uh that they maintain the medical 

964
00:40:59,729 --> 00:41:01,562
standards and a certain level of 

965
00:41:01,562 --> 00:41:03,784
physical fitness to be able to do their 

966
00:41:03,784 --> 00:41:06,007
job . The second is to also identify um 

967
00:41:06,007 --> 00:41:08,450
any health outcomes or health issues of 

968
00:41:08,460 --> 00:41:10,460
of personal concern that need to be 

969
00:41:10,460 --> 00:41:12,682
evaluated and managed further either by 

970
00:41:12,682 --> 00:41:14,904
a primary care provider or a specialist 

971
00:41:14,904 --> 00:41:17,071
as that is going to be referred in for 

972
00:41:17,071 --> 00:41:19,127
their care but also as a function of 

973
00:41:19,127 --> 00:41:21,349
that periodic health assessments , it's 

974
00:41:21,349 --> 00:41:23,516
an additional opportunity to ascertain 

975
00:41:23,516 --> 00:41:25,627
any personal concerns that individual 

976
00:41:25,627 --> 00:41:27,793
may have about exposures um within the 

977
00:41:27,793 --> 00:41:29,960
environment which they operate soldier 

978
00:41:29,960 --> 00:41:31,793
or deploy to . And so you know , 

979
00:41:31,793 --> 00:41:33,793
essentially uh there are three main 

980
00:41:34,010 --> 00:41:36,066
points of care in my view , in which 

981
00:41:36,066 --> 00:41:38,230
these individuals are evaluated is 

982
00:41:38,230 --> 00:41:40,119
downrange if they're experiencing 

983
00:41:40,119 --> 00:41:42,310
symptoms . Um It's when they return 

984
00:41:42,310 --> 00:41:44,032
home as a function of the post 

985
00:41:44,032 --> 00:41:46,199
deployment health assessment process . 

986
00:41:46,199 --> 00:41:48,254
And it's also at least annually on a 

987
00:41:48,254 --> 00:41:50,360
periodic basis um when they're going 

988
00:41:50,360 --> 00:41:52,582
through a periodic health assessments . 

989
00:41:56,310 --> 00:42:00,310
That Yeah . 

990
00:42:01,700 --> 00:42:02,700
As we agreed . 

991
00:42:05,900 --> 00:42:06,900
Yeah . 

992
00:42:09,700 --> 00:42:13,430
What ? Yes are . Mhm . 

993
00:42:14,800 --> 00:42:15,911
1st round and round 

994
00:42:21,800 --> 00:42:23,356
survey . It's pretty cool . 

995
00:42:29,400 --> 00:42:33,230
Yeah . Provided . 

996
00:42:37,300 --> 00:42:41,230
No . Yeah . Right . 

997
00:42:43,600 --> 00:42:45,489
That information is captured in . 

998
00:42:48,340 --> 00:42:51,090
There's been a process you mean by dr 

999
00:42:51,090 --> 00:42:54,820
ross called the comb mammal surveys . 

1000
00:42:55,300 --> 00:42:57,522
It's an interview process . More data . 

1001
00:42:57,600 --> 00:42:59,430
Eat this . Of course . 

1002
00:43:04,500 --> 00:43:07,550
Sure . Becoming that information comes 

1003
00:43:07,560 --> 00:43:11,140
back as these employers with both their 

1004
00:43:13,500 --> 00:43:16,920
You forgot to help specific questions . 

1005
00:43:17,600 --> 00:43:19,711
All right , verbally reviewed on this 

1006
00:43:19,711 --> 00:43:23,070
questionnaire to ensure that it you 

1007
00:43:23,070 --> 00:43:24,848
know , you're you know , you're 

1008
00:43:25,300 --> 00:43:27,800
locations in the registry . Those 

1009
00:43:27,800 --> 00:43:30,230
conditions don't have the expertise . 

1010
00:43:30,800 --> 00:43:34,520
Yeah . Get together and over overseas . 

1011
00:43:36,300 --> 00:43:37,310
Right . Mhm . 

1012
00:43:42,100 --> 00:43:44,180
Criminal health session I think 

1013
00:43:45,300 --> 00:43:47,730
console with those conditions . Mhm . 

1014
00:43:50,140 --> 00:43:52,020
History to that . My commander . 

1015
00:43:55,300 --> 00:43:58,800
Another layer . Mm hmm 

1016
00:44:01,690 --> 00:44:04,400
patient comes to a clinic visit . Has 

1017
00:44:04,400 --> 00:44:06,910
that concern medicine . 

1018
00:44:12,390 --> 00:44:14,750
Thank you senator . Yeah , I agree with 

1019
00:44:14,750 --> 00:44:17,410
my colleagues . I'll just add on that 

1020
00:44:17,420 --> 00:44:20,210
the island does does report those 

1021
00:44:20,210 --> 00:44:22,266
specific questions that we ask about 

1022
00:44:22,266 --> 00:44:24,377
airborne hazards . And so it it pulls 

1023
00:44:24,377 --> 00:44:26,432
that . So not only you're looking at 

1024
00:44:26,432 --> 00:44:28,543
the occupational environmental health 

1025
00:44:28,543 --> 00:44:30,766
risk assessments of when the member was 

1026
00:44:30,766 --> 00:44:32,877
Downrange multiple times . Uh and and 

1027
00:44:32,877 --> 00:44:35,099
you're reviewing those exposures . It's 

1028
00:44:35,099 --> 00:44:37,210
it's taking those those little bit of 

1029
00:44:37,210 --> 00:44:39,043
questions that the member uh has 

1030
00:44:39,043 --> 00:44:41,043
answered regarding airborne hazards 

1031
00:44:41,043 --> 00:44:40,480
from the post deployment health 

1032
00:44:40,480 --> 00:44:42,424
assessment and the periodic health 

1033
00:44:42,424 --> 00:44:45,030
assessment . And we also have a new uh 

1034
00:44:45,040 --> 00:44:47,810
separation health assessment uh that's 

1035
00:44:47,820 --> 00:44:49,820
been under development for the last 

1036
00:44:49,820 --> 00:44:53,040
year , should be re released this fall . 

1037
00:44:53,050 --> 00:44:56,260
And it also goes into detail about 

1038
00:44:56,260 --> 00:44:59,500
airborne hazards and uh uh and 

1039
00:44:59,500 --> 00:45:01,722
chemicals of that nature . And and that 

1040
00:45:01,722 --> 00:45:04,800
will also be documented . Thank you Any 

1041
00:45:04,800 --> 00:45:07,410
further questions . Just one . I just 

1042
00:45:07,410 --> 00:45:09,850
want to Echo Senator Gillibrand or 

1043
00:45:10,790 --> 00:45:12,734
reemphasized Senator Gillibrand on 

1044
00:45:12,740 --> 00:45:15,540
current active burn pits some of the 

1045
00:45:15,550 --> 00:45:18,260
the the process that led to these being 

1046
00:45:18,270 --> 00:45:20,381
operationally necessary I think would 

1047
00:45:20,381 --> 00:45:22,381
be very helpful for the committee . 

1048
00:45:22,490 --> 00:45:25,000
Thank you for being here . Thank you 

1049
00:45:25,000 --> 00:45:26,889
very much for your testimony . Um 

1050
00:45:26,889 --> 00:45:29,000
Welcome the second panel to come on . 

1051
00:45:29,000 --> 00:45:30,111
Thank you very much 

1052
00:47:02,180 --> 00:47:04,600
Right now . Welcome the second panel dr 

1053
00:47:04,610 --> 00:47:06,930
Anthony M . Cisma Director 

1054
00:47:06,930 --> 00:47:09,097
International Center of Excellence and 

1055
00:47:09,097 --> 00:47:10,930
deployment deployment Health and 

1056
00:47:10,930 --> 00:47:13,041
Medical Geosciences North Well Health 

1057
00:47:13,041 --> 00:47:15,340
Foundation Mr Tom Porter . Executive 

1058
00:47:15,350 --> 00:47:17,461
Vice president for Government Affairs 

1059
00:47:17,461 --> 00:47:19,406
Iraq and Afghanistan . Veterans of 

1060
00:47:19,406 --> 00:47:21,183
America . MS Mrs Rosie Torres . 

1061
00:47:21,183 --> 00:47:23,990
Executive Director burn pits 3 60 Mr 

1062
00:47:23,990 --> 00:47:25,490
Stephen patterson . Former 

1063
00:47:25,490 --> 00:47:27,657
environmental science Officer Combined 

1064
00:47:27,657 --> 00:47:29,546
Joint Task Force 101 headquarters 

1065
00:47:29,546 --> 00:47:32,500
Afghanistan from 2000 and 8 , 2009 . Um 

1066
00:47:32,510 --> 00:47:34,621
Thank you so much and each of you can 

1067
00:47:34,621 --> 00:47:36,732
give your opening statements , doctor 

1068
00:47:36,732 --> 00:47:38,843
says ma you you can go dr Cisma , you 

1069
00:47:38,843 --> 00:47:40,690
can go first . Thank you . Chair 

1070
00:47:40,690 --> 00:47:42,746
gillibrand , ranking member Tillis . 

1071
00:47:42,746 --> 00:47:44,857
Members of the personnel subcommittee 

1072
00:47:44,857 --> 00:47:46,720
of the Senate Foreign debt Armed 

1073
00:47:46,720 --> 00:47:48,331
Services committee . For the 

1074
00:47:48,331 --> 00:47:50,442
opportunity to participate in today's 

1075
00:47:50,442 --> 00:47:52,553
hearing Between 1998 and 2015 , I was 

1076
00:47:52,553 --> 00:47:54,720
allergy section Chief Veterans Affairs 

1077
00:47:54,720 --> 00:47:56,887
Medical Center in Northport New York . 

1078
00:47:56,887 --> 00:47:59,040
And my expertise on this issue stems 

1079
00:47:59,040 --> 00:48:01,640
from the following . We my team first 

1080
00:48:01,640 --> 00:48:03,880
reported nuance and asthma among 

1081
00:48:03,880 --> 00:48:06,047
soldiers deployed Iraq and Afghanistan 

1082
00:48:06,047 --> 00:48:09,080
with exposure to burn pits . In 2007 we 

1083
00:48:09,080 --> 00:48:12,800
described deployment related rhinitis 

1084
00:48:12,800 --> 00:48:14,850
in 2000 and eight , coined the term 

1085
00:48:14,850 --> 00:48:17,017
Iraq . Afghanistan war , lung injury I 

1086
00:48:17,017 --> 00:48:19,530
A W . L . I . In 2011 based on lung 

1087
00:48:19,530 --> 00:48:21,970
function , testing data developed 

1088
00:48:21,970 --> 00:48:24,248
animal models with burn pit based dust . 

1089
00:48:24,248 --> 00:48:27,780
In 2000 and 14 tested candidate drugs 

1090
00:48:27,790 --> 00:48:30,260
in these mice in 2000 and 18 and co 

1091
00:48:30,260 --> 00:48:32,371
invented new candidate medicines this 

1092
00:48:32,371 --> 00:48:35,660
year , I am testifying because as a 

1093
00:48:35,660 --> 00:48:38,010
physician , I care about the health and 

1094
00:48:38,010 --> 00:48:40,300
well being of my patients who are our 

1095
00:48:40,300 --> 00:48:42,690
soldiers . The team in my office sees 

1096
00:48:42,690 --> 00:48:44,746
numerous basements , post deployment 

1097
00:48:44,746 --> 00:48:46,579
with a variety of symptoms which 

1098
00:48:46,579 --> 00:48:48,746
includes shortness of breath cloth and 

1099
00:48:48,746 --> 00:48:50,801
chest pain which is accentuated with 

1100
00:48:50,801 --> 00:48:53,110
exercise . I have diagnosed post burn 

1101
00:48:53,110 --> 00:48:55,380
fit exposed soldiers with asthma , non 

1102
00:48:55,380 --> 00:48:58,020
smoking related accelerated COPD 

1103
00:48:58,080 --> 00:48:59,800
constrictive bronchiolitis , 

1104
00:49:00,070 --> 00:49:02,590
carbonaceous burned along 

1105
00:49:03,470 --> 00:49:07,390
titanium law , lung fibrosis , bladder 

1106
00:49:07,390 --> 00:49:10,390
cancer and pulmonary ossification or 

1107
00:49:10,390 --> 00:49:13,670
bone in the lung . In one severe case , 

1108
00:49:13,670 --> 00:49:15,781
for example , one of my patients with 

1109
00:49:15,781 --> 00:49:17,614
lung fibrosis underwent two lung 

1110
00:49:17,614 --> 00:49:19,781
transplants . He just died in december 

1111
00:49:20,570 --> 00:49:22,403
as an expert in the field . I've 

1112
00:49:22,403 --> 00:49:24,626
concluded that these lung disorders are 

1113
00:49:24,626 --> 00:49:26,403
directly related to exposure to 

1114
00:49:26,403 --> 00:49:28,681
airborne hazards , including burn pits , 

1115
00:49:28,681 --> 00:49:30,626
dust storms , improvised explosive 

1116
00:49:30,626 --> 00:49:32,626
devices and blast overpressure from 

1117
00:49:32,626 --> 00:49:34,459
mortar fire grounds . As doctors 

1118
00:49:34,459 --> 00:49:36,681
treating these patients , one challenge 

1119
00:49:36,681 --> 00:49:38,514
we face and that is that there's 

1120
00:49:38,514 --> 00:49:40,681
inadequate screening of these military 

1121
00:49:40,681 --> 00:49:42,792
personnel who are predisposed to lung 

1122
00:49:42,792 --> 00:49:44,903
injury . Lack of screening means they 

1123
00:49:44,903 --> 00:49:46,626
never get diagnosed , they get 

1124
00:49:46,626 --> 00:49:46,590
diagnosed late or they get diagnosed 

1125
00:49:46,590 --> 00:49:48,940
when it's irreversible . The dilemma 

1126
00:49:48,940 --> 00:49:51,051
with military personnel who typically 

1127
00:49:51,051 --> 00:49:53,162
do not have asthma , who passed basic 

1128
00:49:53,162 --> 00:49:55,470
training outdoors , who mass must be 

1129
00:49:55,470 --> 00:49:57,692
fit for deployment at Fort Hood is that 

1130
00:49:57,692 --> 00:49:59,470
they do not have pre deployment 

1131
00:49:59,470 --> 00:50:01,692
pulmonary assessments . Unlike the Fire 

1132
00:50:01,692 --> 00:50:03,914
Department of new york , which was able 

1133
00:50:03,914 --> 00:50:05,970
to determine lung function reduction 

1134
00:50:05,970 --> 00:50:07,803
after 9 11 And otherwise healthy 

1135
00:50:07,803 --> 00:50:09,692
soldier who is 100% predicted pre 

1136
00:50:09,692 --> 00:50:11,914
deployment , who goes down to 80% has a 

1137
00:50:11,914 --> 00:50:13,637
significant decrease . Another 

1138
00:50:13,637 --> 00:50:15,526
challenge we face is that doctors 

1139
00:50:15,526 --> 00:50:17,526
treating these service members is a 

1140
00:50:17,526 --> 00:50:19,692
lack of information we receive without 

1141
00:50:19,692 --> 00:50:21,637
knowing what they're exposed to or 

1142
00:50:21,637 --> 00:50:23,748
potentially exposed to . It's hard to 

1143
00:50:23,748 --> 00:50:25,748
prove what caused the ailment . For 

1144
00:50:25,748 --> 00:50:27,859
example , last month , one patient of 

1145
00:50:27,859 --> 00:50:30,140
mine was denied a console to the East 

1146
00:50:30,140 --> 00:50:32,251
Orange War related illness and injury 

1147
00:50:32,251 --> 00:50:34,362
center because the local V . A doctor 

1148
00:50:34,362 --> 00:50:36,251
said he did not believe that that 

1149
00:50:36,251 --> 00:50:38,251
military firefighters sleep apnea , 

1150
00:50:38,251 --> 00:50:40,251
sinusitis , asthma and writers were 

1151
00:50:40,251 --> 00:50:42,307
related to deployment even though he 

1152
00:50:42,307 --> 00:50:44,196
had a positive sleep study during 

1153
00:50:44,196 --> 00:50:46,320
active service , even if it is known 

1154
00:50:46,320 --> 00:50:48,209
that there are toxic materials at 

1155
00:50:48,209 --> 00:50:50,264
certain sites . Often soldiers visit 

1156
00:50:50,264 --> 00:50:52,320
our academic center without complete 

1157
00:50:52,320 --> 00:50:54,320
documentation of locations of their 

1158
00:50:54,320 --> 00:50:56,320
deployment so their direct exposure 

1159
00:50:56,320 --> 00:50:58,431
cannot be proven . This is especially 

1160
00:50:58,431 --> 00:51:00,264
the case if they were at forward 

1161
00:51:00,264 --> 00:51:02,487
operating bases like camp striker whose 

1162
00:51:02,487 --> 00:51:04,542
exact location is not on the map . I 

1163
00:51:04,542 --> 00:51:06,764
have several recommendations to address 

1164
00:51:06,764 --> 00:51:08,709
these challenges and ensure we are 

1165
00:51:08,709 --> 00:51:10,764
taking care of our service members . 

1166
00:51:11,060 --> 00:51:13,640
one conduct breathing tests before and 

1167
00:51:13,640 --> 00:51:16,850
after deployment to revamp the D . O . 

1168
00:51:16,850 --> 00:51:18,850
D . Method of documenting locations 

1169
00:51:18,850 --> 00:51:21,350
where military personnel served . Three 

1170
00:51:21,360 --> 00:51:23,304
utilize newer technologies such as 

1171
00:51:23,304 --> 00:51:25,560
wearable particle monitors . First by 

1172
00:51:25,560 --> 00:51:27,671
conducting breathing tests before and 

1173
00:51:27,671 --> 00:51:29,838
after deployment . We can determine if 

1174
00:51:29,838 --> 00:51:31,949
there is a reduction in lung function 

1175
00:51:31,949 --> 00:51:33,838
much earlier than if we wait . In 

1176
00:51:33,838 --> 00:51:35,727
addition , these data will better 

1177
00:51:35,727 --> 00:51:37,893
enable screening protocols to identify 

1178
00:51:37,893 --> 00:51:40,060
who are soldiers at risk . Second , by 

1179
00:51:40,060 --> 00:51:42,060
revamping the D . O . D . Method of 

1180
00:51:42,060 --> 00:51:44,060
documenting locations with military 

1181
00:51:44,060 --> 00:51:45,782
personnel served with a better 

1182
00:51:45,782 --> 00:51:48,004
understanding what they're exposed to a 

1183
00:51:48,004 --> 00:51:50,227
better understanding of the illness and 

1184
00:51:50,227 --> 00:51:52,393
how to treat it . Third , by utilizing 

1185
00:51:52,393 --> 00:51:54,393
newer technologies such as wearable 

1186
00:51:54,393 --> 00:51:56,504
particle monitors with gPS . We'll be 

1187
00:51:56,504 --> 00:51:58,282
able to assess a given soldiers 

1188
00:51:58,282 --> 00:52:00,504
exposure and location by utilizing this 

1189
00:52:00,504 --> 00:52:02,671
for contingent of military personnel . 

1190
00:52:02,671 --> 00:52:04,838
The D . O . D . Will be better able to 

1191
00:52:04,838 --> 00:52:06,949
move troops to regions of safety away 

1192
00:52:06,949 --> 00:52:08,949
from airborne hazards . If exposure 

1193
00:52:08,949 --> 00:52:10,949
does happen , it would also provide 

1194
00:52:10,949 --> 00:52:13,171
critical information for treatment . We 

1195
00:52:13,171 --> 00:52:15,116
know that screening and monitoring 

1196
00:52:15,116 --> 00:52:17,227
programs have been extremely affected 

1197
00:52:17,227 --> 00:52:19,282
for those victims of the World Trade 

1198
00:52:19,282 --> 00:52:21,393
Center disaster post 9 11 And this is 

1199
00:52:21,393 --> 00:52:23,616
an analogous exposure with JP eight and 

1200
00:52:23,616 --> 00:52:25,900
burn pits . It is our sacred duty to 

1201
00:52:25,900 --> 00:52:28,230
care for the women and men who 

1202
00:52:28,230 --> 00:52:30,560
sacrificed their lives for our freedom . 

1203
00:52:30,950 --> 00:52:34,910
Yeah , thank you . Dr Cisma Mr 

1204
00:52:34,910 --> 00:52:38,650
Porter . Right , thank you 

1205
00:52:38,650 --> 00:52:40,540
for for having us here . Senator 

1206
00:52:40,540 --> 00:52:42,262
Gillibrand in center . Tell us 

1207
00:52:42,262 --> 00:52:44,484
appreciate everything that you're doing 

1208
00:52:44,484 --> 00:52:46,318
on this issue . Um , I'd like to 

1209
00:52:46,318 --> 00:52:48,318
introduce my daughter , 13 year old 

1210
00:52:48,318 --> 00:52:50,318
daughter here at Elizabeth Porter . 

1211
00:52:50,318 --> 00:52:52,540
She's playing hooky from school today , 

1212
00:52:52,540 --> 00:52:51,930
so hopefully she gets something out of 

1213
00:52:51,930 --> 00:52:55,690
this . Um , I also want to , on a 

1214
00:52:55,700 --> 00:52:57,922
more serious note , I want to take this 

1215
00:52:57,922 --> 00:53:00,180
opportunity to say that my thoughts and 

1216
00:53:00,180 --> 00:53:03,490
prayers are with dr kate Hendrix thomas 

1217
00:53:03,500 --> 00:53:06,590
advocate on this issue . She's going 

1218
00:53:06,590 --> 00:53:08,646
through very particularly tough time 

1219
00:53:08,646 --> 00:53:10,701
with her with regard to her burn pit 

1220
00:53:10,701 --> 00:53:13,930
related illness . Um , so I'm here not 

1221
00:53:13,930 --> 00:53:16,240
only as an ivy advocate but as one who 

1222
00:53:16,240 --> 00:53:18,296
was exposed to a variety of airborne 

1223
00:53:18,296 --> 00:53:20,629
toxins from burn pits and other sources . 

1224
00:53:20,629 --> 00:53:22,796
While it's deployed before I went down 

1225
00:53:22,796 --> 00:53:25,073
range . I had completely healthy lungs . 

1226
00:53:25,350 --> 00:53:27,360
Shortly after I arrived in Kabul in 

1227
00:53:27,360 --> 00:53:29,980
2010 where the air is particularly bad . 

1228
00:53:29,980 --> 00:53:32,091
My lungs had a severe reaction became 

1229
00:53:32,091 --> 00:53:34,258
infected . It was controlled with with 

1230
00:53:34,258 --> 00:53:36,790
medication , but I was diagnosed with 

1231
00:53:36,790 --> 00:53:38,790
asthma as soon as I got back home a 

1232
00:53:38,790 --> 00:53:41,740
year later . Um but I have to still 

1233
00:53:41,750 --> 00:53:43,528
take the medications to keep my 

1234
00:53:43,528 --> 00:53:46,370
breathing under uh to keep breathing , 

1235
00:53:46,750 --> 00:53:50,730
um exposure to the burn pits uh 

1236
00:53:50,740 --> 00:53:52,851
used by military to destroy medical , 

1237
00:53:52,851 --> 00:53:54,962
human waste , chemicals , petroleum , 

1238
00:53:54,962 --> 00:53:57,820
other other trash . Um It's been 

1239
00:53:57,820 --> 00:53:59,987
widespread . We've talked about this a 

1240
00:53:59,987 --> 00:54:01,987
lot here already . Um It's not just 

1241
00:54:01,987 --> 00:54:05,020
burn pits . Um You can learn a lot from 

1242
00:54:05,020 --> 00:54:06,964
those who have served in Kabul for 

1243
00:54:06,964 --> 00:54:09,187
example . It's an enormous city without 

1244
00:54:09,187 --> 00:54:11,409
a modern sewage system . Uh Many of you 

1245
00:54:11,409 --> 00:54:13,576
serve their suffering the impacts from 

1246
00:54:13,576 --> 00:54:15,990
breathing airborne feces for extended 

1247
00:54:15,990 --> 00:54:18,212
periods of time . Uh and there are also 

1248
00:54:18,212 --> 00:54:20,660
burn pits there at many of the bases in 

1249
00:54:20,660 --> 00:54:23,280
that city alone at every location where 

1250
00:54:23,280 --> 00:54:25,280
U . S . And coalition military were 

1251
00:54:25,280 --> 00:54:27,613
stationed . There were many porta johns . 

1252
00:54:27,613 --> 00:54:29,980
It was somebody's job to pull out that 

1253
00:54:29,980 --> 00:54:32,036
metal bend from the portage in every 

1254
00:54:32,036 --> 00:54:34,960
day , douse it with jet fuel and burn 

1255
00:54:34,960 --> 00:54:37,182
it down to a brick . And that's how you 

1256
00:54:37,182 --> 00:54:39,182
get rid of the Porta john waste and 

1257
00:54:39,182 --> 00:54:41,404
it's somebody's job to do that . Um and 

1258
00:54:41,404 --> 00:54:43,571
it's , I don't need to describe that's 

1259
00:54:43,571 --> 00:54:46,550
particularly nasty job . Um The 

1260
00:54:46,550 --> 00:54:48,772
military and veteran community know all 

1261
00:54:48,772 --> 00:54:50,661
too well the detrimental . Um how 

1262
00:54:50,661 --> 00:54:52,772
detrimental the talk to exposures can 

1263
00:54:52,772 --> 00:54:55,390
be referred to . Our new members survey 

1264
00:54:55,390 --> 00:54:57,510
that that's just out this month for 

1265
00:54:57,520 --> 00:55:00,580
2022 . We surveyed our members , 82% of 

1266
00:55:00,580 --> 00:55:03,420
our members say they experienced toxic 

1267
00:55:03,420 --> 00:55:05,550
exposures during their service . Of 

1268
00:55:05,550 --> 00:55:08,910
those , 90% say they have or may have 

1269
00:55:08,910 --> 00:55:12,040
symptoms as a result Of the 82% who 

1270
00:55:12,040 --> 00:55:14,280
were exposed just 53% . So they had 

1271
00:55:14,280 --> 00:55:17,110
their exposures documented uh in their 

1272
00:55:17,110 --> 00:55:19,443
d . o . d . periodic health assessments . 

1273
00:55:19,443 --> 00:55:22,680
So just 53% . Uh this data shows the 

1274
00:55:22,680 --> 00:55:24,736
enormous percentage of those who are 

1275
00:55:24,736 --> 00:55:26,847
suffering service-related exposures . 

1276
00:55:26,847 --> 00:55:28,847
Especially considering the estimate 

1277
00:55:28,847 --> 00:55:31,480
that via has of as many as 3.5 million 

1278
00:55:31,480 --> 00:55:33,810
that could have been exposed . Um When 

1279
00:55:33,810 --> 00:55:36,032
I A . V . A . Saw a similar data . In a 

1280
00:55:36,032 --> 00:55:38,199
previous member survey we conceived of 

1281
00:55:38,199 --> 00:55:40,310
and worked hard to pass the burn pits 

1282
00:55:40,310 --> 00:55:42,532
accountability act . That was passed in 

1283
00:55:42,532 --> 00:55:45,560
2020 within the N . D . A . Um So this 

1284
00:55:45,570 --> 00:55:48,980
would the law required service members 

1285
00:55:48,980 --> 00:55:50,980
to be evaluated for exposures doing 

1286
00:55:50,980 --> 00:55:53,290
routine health exams . Service members 

1287
00:55:53,290 --> 00:55:55,290
were required to be enrolled in the 

1288
00:55:55,290 --> 00:55:57,512
burn pit registry unless they opt out . 

1289
00:55:57,840 --> 00:56:00,490
Um If they suffered exposures or if 

1290
00:56:00,490 --> 00:56:02,601
they were stationed near a burn pit , 

1291
00:56:02,790 --> 00:56:05,630
76% of IA v . A members were aware of 

1292
00:56:05,630 --> 00:56:07,470
the registry but only 59% are 

1293
00:56:07,470 --> 00:56:09,740
registered in it . D . O . D . Must 

1294
00:56:09,740 --> 00:56:12,480
maximize its efforts to ensure all who 

1295
00:56:12,480 --> 00:56:14,760
are eligible to get enrolled . Not just 

1296
00:56:14,760 --> 00:56:17,960
informed of it . As the law requires , 

1297
00:56:17,970 --> 00:56:20,137
it requires them to be enrolled in the 

1298
00:56:20,137 --> 00:56:22,359
registry . And that's the intent behind 

1299
00:56:22,359 --> 00:56:24,526
the law in the first place . And we we 

1300
00:56:24,526 --> 00:56:26,581
know this because we work to develop 

1301
00:56:26,581 --> 00:56:28,748
the bill and pass it . Um I would like 

1302
00:56:28,748 --> 00:56:30,970
to D . O . D . To confirm if the letter 

1303
00:56:30,970 --> 00:56:32,526
and intent of the burn pits 

1304
00:56:32,526 --> 00:56:34,581
accountability act of being executed 

1305
00:56:34,581 --> 00:56:36,692
including whether service members are 

1306
00:56:36,692 --> 00:56:38,748
actually being required to enroll in 

1307
00:56:38,748 --> 00:56:40,970
the registry or simply being advised of 

1308
00:56:40,970 --> 00:56:43,026
its existence . Um We heard a lot of 

1309
00:56:43,026 --> 00:56:44,970
talk already today about the Isler 

1310
00:56:44,970 --> 00:56:47,137
database that's really critical . Well 

1311
00:56:47,137 --> 00:56:49,359
we believe it's uh that they would help 

1312
00:56:49,359 --> 00:56:51,581
inform service members veterans and the 

1313
00:56:51,581 --> 00:56:54,120
medical providers of the the exposures 

1314
00:56:54,130 --> 00:56:55,963
by your location and time you're 

1315
00:56:55,963 --> 00:56:58,490
deployed . Um I think we heard that it 

1316
00:56:58,490 --> 00:57:02,140
was supposed to be operational in 2023 , 

1317
00:57:02,480 --> 00:57:05,390
2023 is what I understand . Um we 

1318
00:57:05,400 --> 00:57:07,400
supported legislation that required 

1319
00:57:07,400 --> 00:57:10,290
that that veterans have access to their 

1320
00:57:10,290 --> 00:57:13,220
island database um online . So 

1321
00:57:13,230 --> 00:57:15,390
hopefully that is it that it stays on 

1322
00:57:15,390 --> 00:57:17,920
track for implementation by September 

1323
00:57:17,920 --> 00:57:20,142
2023 . And we'd like your assistance to 

1324
00:57:20,142 --> 00:57:23,060
try to ensure that that happens . Um 

1325
00:57:23,070 --> 00:57:25,292
There's also been some talk in the news 

1326
00:57:25,292 --> 00:57:27,070
about the Red Hill fuel storage 

1327
00:57:27,070 --> 00:57:29,260
facility in Hawaii . Um Yeah this is 

1328
00:57:29,260 --> 00:57:31,427
another toxic exposure so it's not all 

1329
00:57:31,427 --> 00:57:34,340
burn pits . Um The uh we want to make 

1330
00:57:34,340 --> 00:57:36,800
sure that the D . O . D . Documents 

1331
00:57:36,800 --> 00:57:39,290
those exposures to not only the service 

1332
00:57:39,290 --> 00:57:41,457
members that are serving there now but 

1333
00:57:41,457 --> 00:57:44,270
have been dislocated . Um but then also 

1334
00:57:44,280 --> 00:57:46,447
the those that have been impacted over 

1335
00:57:46,447 --> 00:57:48,669
the life of the fuel storage facility . 

1336
00:57:48,669 --> 00:57:50,780
That's important . How are they going 

1337
00:57:50,780 --> 00:57:52,836
to be doing that ? Um Serving in the 

1338
00:57:52,836 --> 00:57:54,836
military is tough on one's body . I 

1339
00:57:54,836 --> 00:57:56,669
don't think that's surprising to 

1340
00:57:56,669 --> 00:57:58,891
anybody here . Um although not specific 

1341
00:57:58,891 --> 00:58:00,836
to toxic exposure is a significant 

1342
00:58:00,836 --> 00:58:03,002
indicator of ivy members health . When 

1343
00:58:03,002 --> 00:58:05,058
asked in our members survey how they 

1344
00:58:05,058 --> 00:58:07,224
would rate their overall health before 

1345
00:58:07,224 --> 00:58:09,930
joining the military , 91 rated their 

1346
00:58:09,930 --> 00:58:12,150
health as excellent or good . When 

1347
00:58:12,150 --> 00:58:14,372
asked how they rated their health after 

1348
00:58:14,372 --> 00:58:16,600
they left the military , just 33% said 

1349
00:58:16,600 --> 00:58:18,970
it was excellent or good . The military 

1350
00:58:18,970 --> 00:58:21,081
service can be hard and cause adverse 

1351
00:58:21,081 --> 00:58:23,390
health impacts . It's not a surprise . 

1352
00:58:23,400 --> 00:58:25,750
Um But those who may want to encourage 

1353
00:58:25,750 --> 00:58:27,861
their sons and daughters to enter the 

1354
00:58:27,861 --> 00:58:30,100
military expect it if one does suffer 

1355
00:58:30,100 --> 00:58:32,322
injuries . Our government will care for 

1356
00:58:32,322 --> 00:58:34,520
them when they come home , failure to 

1357
00:58:34,520 --> 00:58:36,750
care for the many who suffered toxic 

1358
00:58:36,750 --> 00:58:38,750
exposures may diminish the value of 

1359
00:58:38,750 --> 00:58:40,950
military service in the public's eyes 

1360
00:58:40,970 --> 00:58:43,500
and by refusing to satisfy our 

1361
00:58:43,500 --> 00:58:45,722
obligations to them , we communicate to 

1362
00:58:45,722 --> 00:58:47,944
current and future service members that 

1363
00:58:47,944 --> 00:58:50,056
we do not actually have their backs . 

1364
00:58:50,320 --> 00:58:52,542
So on behalf of the 3.5 million service 

1365
00:58:52,542 --> 00:58:54,431
members and veterans who may have 

1366
00:58:54,431 --> 00:58:56,653
suffered toxic exposures , I'm employee 

1367
00:58:56,653 --> 00:58:58,598
to ensure that D . O . D . Follows 

1368
00:58:58,598 --> 00:59:00,820
recently enacted laws meant to increase 

1369
00:59:00,820 --> 00:59:02,876
transparency and information sharing 

1370
00:59:02,876 --> 00:59:05,042
with those who have suffered exposures 

1371
00:59:05,042 --> 00:59:07,180
and despair . No effort in not only 

1372
00:59:07,180 --> 00:59:09,720
anticipating new hazards our personnel 

1373
00:59:09,720 --> 00:59:11,720
may encounter , but advised them of 

1374
00:59:11,720 --> 00:59:13,900
their known risks ahead of time . So 

1375
00:59:13,900 --> 00:59:15,844
they and medical professionals are 

1376
00:59:15,844 --> 00:59:17,844
better equipped to address emergent 

1377
00:59:17,844 --> 00:59:19,956
health impacts again . Thank you very 

1378
00:59:19,956 --> 00:59:22,067
much for having me today and happy to 

1379
00:59:22,067 --> 00:59:25,240
answer any questions . Mrs Torres . Yes , 

1380
00:59:26,020 --> 00:59:28,020
thank you . Chairwoman Gillibrand , 

1381
00:59:28,020 --> 00:59:30,076
ranking member Tillis and members of 

1382
00:59:30,076 --> 00:59:32,131
the subcommittee for today's hearing 

1383
00:59:32,131 --> 00:59:34,242
and for this opportunity to testify . 

1384
00:59:34,242 --> 00:59:36,131
It seems like yesterday when some 

1385
00:59:36,131 --> 00:59:38,242
members of Congress believed that the 

1386
00:59:38,242 --> 00:59:40,242
health risks of toxic exposures and 

1387
00:59:40,242 --> 00:59:42,131
burn pits were based on anecdotal 

1388
00:59:42,131 --> 00:59:44,242
evidence . While we have data today . 

1389
00:59:44,242 --> 00:59:46,464
That shows otherwise , I'm here to tell 

1390
00:59:46,464 --> 00:59:48,687
you personally about the stories of the 

1391
00:59:48,687 --> 00:59:50,853
men and women who bravely defended our 

1392
00:59:50,853 --> 00:59:53,076
country exposed to toxic chemicals that 

1393
00:59:53,076 --> 00:59:55,180
for many cost them their life . My 

1394
00:59:55,180 --> 00:59:57,410
story begins with my husband , retired 

1395
00:59:57,410 --> 00:59:59,910
Captain Leroy Torres who served as a 

1396
00:59:59,910 --> 01:00:02,860
texas state trooper for 14 years and as 

1397
01:00:02,860 --> 01:00:05,580
a soldier for 23 years before being 

1398
01:00:05,580 --> 01:00:09,020
medically retired . He deployed to 

1399
01:00:09,020 --> 01:00:11,770
Balad Iraq from 2007 to 2008 where he 

1400
01:00:11,770 --> 01:00:13,770
was exposed to the largest burn pit 

1401
01:00:13,770 --> 01:00:15,714
within the Operation Iraqi Freedom 

1402
01:00:15,714 --> 01:00:17,826
Theatre of Operations , which was the 

1403
01:00:17,826 --> 01:00:20,103
size of approximately a football field . 

1404
01:00:20,710 --> 01:00:22,821
He lived and worked next to the toxic 

1405
01:00:22,821 --> 01:00:24,932
plume of black smoke that infiltrated 

1406
01:00:24,932 --> 01:00:27,070
where they lived ate and slept . He 

1407
01:00:27,070 --> 01:00:29,014
returned home from war to face the 

1408
01:00:29,014 --> 01:00:31,181
health care system that failed him and 

1409
01:00:31,181 --> 01:00:34,840
an employer too afraid to understand an 

1410
01:00:34,850 --> 01:00:36,780
uncommon war injury resulting in 

1411
01:00:36,780 --> 01:00:38,870
termination of his law enforcement 

1412
01:00:38,870 --> 01:00:41,300
career . As a result of these 

1413
01:00:41,300 --> 01:00:43,522
injustices , Leroy attempted to end his 

1414
01:00:43,522 --> 01:00:46,900
life in 2016 Since returning from Iraq . 

1415
01:00:46,910 --> 01:00:49,600
He's had over 400 medical visits until 

1416
01:00:49,600 --> 01:00:51,267
he was finally diagnosed with 

1417
01:00:51,267 --> 01:00:53,489
autoimmune disease , toxic brain injury 

1418
01:00:54,310 --> 01:00:56,143
and constrictive bronchiolitis . 

1419
01:00:56,143 --> 01:00:58,254
Following a lung biopsy at Vanderbilt 

1420
01:00:58,254 --> 01:01:00,532
University , the V . A . N . D . O . D . 

1421
01:01:00,532 --> 01:01:02,630
Refused to recognize or diagnoses 

1422
01:01:02,630 --> 01:01:04,960
environmental injuries , often 

1423
01:01:04,970 --> 01:01:07,570
misdiagnosing them as psychosomatic or 

1424
01:01:07,570 --> 01:01:11,320
dismissing them as compensation driven 

1425
01:01:11,330 --> 01:01:13,820
care seeking . The more veterans we 

1426
01:01:13,820 --> 01:01:15,820
talked to , the more we heard about 

1427
01:01:15,820 --> 01:01:17,931
stories like Leroy's . This is why 12 

1428
01:01:17,931 --> 01:01:20,098
years ago , Lyra and I co founded burn 

1429
01:01:20,098 --> 01:01:22,760
pits 3 60 a nonprofit that advocates 

1430
01:01:22,760 --> 01:01:24,593
for veterans service members and 

1431
01:01:24,593 --> 01:01:26,538
families of the fallen affected by 

1432
01:01:26,538 --> 01:01:28,649
toxic exposures . We created a health 

1433
01:01:28,649 --> 01:01:30,830
registry of about 10,000 participants 

1434
01:01:30,830 --> 01:01:33,090
to track their exposure diseases and 

1435
01:01:33,090 --> 01:01:35,050
deaths . Working with doctors like 

1436
01:01:35,050 --> 01:01:37,270
doctors Emma , we then joined in 

1437
01:01:37,270 --> 01:01:40,420
Washington and gathered uh , with other 

1438
01:01:40,420 --> 01:01:44,180
families in in To 

1439
01:01:44,180 --> 01:01:46,402
pass the the Airborne Hazards Open Burn 

1440
01:01:46,402 --> 01:01:49,740
Pit Registry Act of 2013 . We've been 

1441
01:01:49,750 --> 01:01:51,861
too far too many funerals and consult 

1442
01:01:51,861 --> 01:01:53,750
countless of wives , husbands and 

1443
01:01:53,750 --> 01:01:55,972
Children left alone by our government's 

1444
01:01:55,972 --> 01:01:58,139
failure to treat our nation's veterans 

1445
01:01:58,139 --> 01:02:00,361
burn pits . 3 60 has persevered through 

1446
01:02:00,361 --> 01:02:02,472
the years despite the indifference of 

1447
01:02:02,472 --> 01:02:04,472
the V . A . D . O . D . In congress 

1448
01:02:04,472 --> 01:02:06,194
instead of providing them with 

1449
01:02:06,194 --> 01:02:08,361
treatment early cancer diagnostics and 

1450
01:02:08,361 --> 01:02:10,361
benefits . Our government spent the 

1451
01:02:10,361 --> 01:02:12,528
last years telling veterans , there is 

1452
01:02:12,528 --> 01:02:14,639
no evidence that inhaling toxic black 

1453
01:02:14,639 --> 01:02:17,090
smoke causes respiratory illnesses and 

1454
01:02:17,090 --> 01:02:19,820
cancers that their stories or anecdotes 

1455
01:02:19,830 --> 01:02:22,690
and not data and that treating them is 

1456
01:02:22,690 --> 01:02:25,550
too costly . I cannot help but wonder 

1457
01:02:25,560 --> 01:02:27,560
what is the cost of their lives and 

1458
01:02:27,560 --> 01:02:29,720
sacrifice . So now more than ever we 

1459
01:02:29,720 --> 01:02:32,270
need to pass legislation that addresses 

1460
01:02:32,270 --> 01:02:35,530
presumption . The time is well past due 

1461
01:02:35,540 --> 01:02:37,651
for the president , the Department of 

1462
01:02:37,651 --> 01:02:40,340
Defense veteran Affairs to acknowledge 

1463
01:02:40,340 --> 01:02:42,960
these injuries and disease as a direct 

1464
01:02:42,960 --> 01:02:45,680
result of armed conflict or caused by 

1465
01:02:45,680 --> 01:02:48,010
an instrumentality of war . We are 

1466
01:02:48,020 --> 01:02:50,220
asking for the Department of Defense 

1467
01:02:50,230 --> 01:02:52,174
and Veteran Affairs to honor these 

1468
01:02:52,174 --> 01:02:54,920
injuries with compassionate common 

1469
01:02:54,920 --> 01:02:57,660
sense . This is an invitation to begin 

1470
01:02:57,660 --> 01:02:59,827
the healing process for these families 

1471
01:02:59,827 --> 01:03:01,993
who have lost loved ones to illness or 

1472
01:03:01,993 --> 01:03:03,882
death following the environmental 

1473
01:03:03,882 --> 01:03:06,104
hardships of war . Yet Leroy's story is 

1474
01:03:06,104 --> 01:03:08,049
not the only one . Sergeant thomas 

1475
01:03:08,049 --> 01:03:10,216
joseph Sullivan served with the United 

1476
01:03:10,216 --> 01:03:12,382
States , Marine and Iraq . He suffered 

1477
01:03:12,382 --> 01:03:14,716
from intestinal ulceration and bleeding , 

1478
01:03:14,716 --> 01:03:16,771
hypertension , respiratory disease . 

1479
01:03:16,771 --> 01:03:18,827
Asthma and liver disorder . Tom died 

1480
01:03:18,827 --> 01:03:21,910
2009 at 30 years old . Will Thompson 

1481
01:03:21,920 --> 01:03:23,976
served with the US Army for 23 years 

1482
01:03:23,976 --> 01:03:26,031
and was deployed twice to Iraq . His 

1483
01:03:26,031 --> 01:03:28,364
doctors treated his cough has allergies . 

1484
01:03:28,364 --> 01:03:30,476
He was later diagnosed with pneumonia 

1485
01:03:30,476 --> 01:03:32,753
treated with antibiotics and sent home . 

1486
01:03:32,753 --> 01:03:34,587
Eventually he was diagnosed with 

1487
01:03:34,587 --> 01:03:36,476
pulmonary fibrosis . After a lung 

1488
01:03:36,476 --> 01:03:38,610
biopsy , he was informed that he had 

1489
01:03:38,610 --> 01:03:42,120
titanium , magnesium , iron and silica 

1490
01:03:42,120 --> 01:03:44,590
in his lungs Will underwent two 

1491
01:03:44,590 --> 01:03:46,534
transplants and passed away . This 

1492
01:03:46,534 --> 01:03:49,080
december at 50 years old , Lieutenant 

1493
01:03:49,080 --> 01:03:50,691
Colonel dan brewer , centcom 

1494
01:03:50,691 --> 01:03:52,590
environmental officer deployed to 

1495
01:03:52,590 --> 01:03:55,090
Afghanistan and warned his supervisors 

1496
01:03:55,120 --> 01:03:57,231
about the health effects of the black 

1497
01:03:57,231 --> 01:03:59,287
fumes caused by burning of waste and 

1498
01:03:59,287 --> 01:04:02,210
plastic at night . Lastly , Isiah James 

1499
01:04:02,590 --> 01:04:04,590
Served with the us army deployed to 

1500
01:04:04,590 --> 01:04:07,930
Iraq 2006 , 2008 - 2009 in 

1501
01:04:07,930 --> 01:04:11,710
Afghanistan 2010 , and 

1502
01:04:11,710 --> 01:04:14,100
Isaiah says this , he is now suffering 

1503
01:04:14,100 --> 01:04:15,790
from lung disease and is on 

1504
01:04:15,800 --> 01:04:18,450
supplemental oxygen . He says it is my 

1505
01:04:18,450 --> 01:04:20,339
hope . You not only listen to the 

1506
01:04:20,339 --> 01:04:23,250
testimony but to hear it , to feel it , 

1507
01:04:23,260 --> 01:04:25,870
to understand it and most importantly 

1508
01:04:25,870 --> 01:04:28,390
to act on it . History is the ultimate 

1509
01:04:28,390 --> 01:04:30,570
judge and we in this country have not 

1510
01:04:30,570 --> 01:04:32,681
always done best by those who we sent 

1511
01:04:32,681 --> 01:04:34,950
in our stead . I believe it was 

1512
01:04:34,960 --> 01:04:37,760
Churchill who said never has so much 

1513
01:04:37,760 --> 01:04:40,110
been owed to so few by so many . How 

1514
01:04:40,110 --> 01:04:42,332
will you be judged and how will America 

1515
01:04:42,332 --> 01:04:44,610
and the american people pay their debt . 

1516
01:04:49,290 --> 01:04:50,957
Senators , thank you for this 

1517
01:04:50,957 --> 01:04:53,068
opportunity . I'm Stephen Patterson , 

1518
01:04:53,068 --> 01:04:54,957
retired environmental science and 

1519
01:04:54,957 --> 01:04:57,068
engineering officer . This falls into 

1520
01:04:57,068 --> 01:04:59,012
the larger preventive medicine and 

1521
01:04:59,012 --> 01:05:01,179
community that was mentioned earlier . 

1522
01:05:01,179 --> 01:05:03,346
I'm here today to assist you with your 

1523
01:05:03,346 --> 01:05:02,600
understanding of burn pits , 

1524
01:05:02,600 --> 01:05:04,767
environmental health exposures and how 

1525
01:05:04,767 --> 01:05:06,989
those were documented primarily . I can 

1526
01:05:06,989 --> 01:05:09,211
speak to the time of 2000 and eight and 

1527
01:05:09,211 --> 01:05:11,100
2000 and nine when I was a senior 

1528
01:05:11,100 --> 01:05:12,989
environmental science officer For 

1529
01:05:12,989 --> 01:05:15,100
combined Joint Task Force 101 . While 

1530
01:05:15,100 --> 01:05:17,322
it was the headquarters for Afghanistan 

1531
01:05:17,322 --> 01:05:19,211
in this position , I traveled the 

1532
01:05:19,211 --> 01:05:18,980
nation extensively and saw most of the 

1533
01:05:18,980 --> 01:05:20,980
locations where U . S . Forces were 

1534
01:05:20,980 --> 01:05:23,091
deployed . My job was to conserve the 

1535
01:05:23,091 --> 01:05:24,647
fighting force and identify 

1536
01:05:24,647 --> 01:05:26,702
environmental health exposures . The 

1537
01:05:26,702 --> 01:05:28,313
deployed environment is very 

1538
01:05:28,313 --> 01:05:30,424
challenging and it's very difficult , 

1539
01:05:30,424 --> 01:05:32,591
difficult documented persons exposures 

1540
01:05:32,591 --> 01:05:34,647
in such a setting . The equipment to 

1541
01:05:34,647 --> 01:05:36,591
identify and quantify exposures is 

1542
01:05:36,591 --> 01:05:38,869
often lacking as are trained personnel , 

1543
01:05:38,869 --> 01:05:40,980
especially in remote locations . This 

1544
01:05:40,980 --> 01:05:43,202
is made more difficult as we often have 

1545
01:05:43,202 --> 01:05:42,970
exposures which one would not 

1546
01:05:42,970 --> 01:05:45,137
anticipate as well as the challenge of 

1547
01:05:45,137 --> 01:05:47,303
accurately placing a certain person in 

1548
01:05:47,303 --> 01:05:49,470
a location at a given time . This is 

1549
01:05:49,470 --> 01:05:51,692
made worse when attempting to look back 

1550
01:05:51,692 --> 01:05:53,803
10 or 20 years . His camp names often 

1551
01:05:53,803 --> 01:05:55,859
change and the personnel system does 

1552
01:05:55,859 --> 01:05:58,081
not operate down to the person . Almost 

1553
01:05:58,081 --> 01:06:00,137
all the locations I visited had burn 

1554
01:06:00,137 --> 01:06:02,303
pits operating at that time and few if 

1555
01:06:02,303 --> 01:06:04,248
any , separated their waste before 

1556
01:06:04,248 --> 01:06:05,970
burning it . So many contained 

1557
01:06:05,970 --> 01:06:08,192
pressurized lumber , galvanized metal , 

1558
01:06:08,192 --> 01:06:10,359
significant quantities of plastics and 

1559
01:06:10,359 --> 01:06:12,692
lithium batteries . These were not pits , 

1560
01:06:12,692 --> 01:06:14,748
but simply low lying areas where the 

1561
01:06:14,748 --> 01:06:16,970
waste was thrown and burned . Typically 

1562
01:06:16,970 --> 01:06:19,026
they smoldered a great deal which is 

1563
01:06:19,026 --> 01:06:18,580
important as the combustion is not 

1564
01:06:18,580 --> 01:06:20,640
complete . More toxic compounds may 

1565
01:06:20,640 --> 01:06:22,870
form and these toxins are not lifted 

1566
01:06:22,880 --> 01:06:26,030
lifted away , so stay near or in the 

1567
01:06:26,030 --> 01:06:28,240
air around the camp , most of these 

1568
01:06:28,240 --> 01:06:30,240
burn pits were within the perimeter 

1569
01:06:30,240 --> 01:06:32,296
fence for security reasons , or very 

1570
01:06:32,296 --> 01:06:34,462
close to the perimeter . If outside of 

1571
01:06:34,462 --> 01:06:36,629
the camp , most of the small camps had 

1572
01:06:36,629 --> 01:06:38,796
few if any , air samples taken at them 

1573
01:06:38,796 --> 01:06:40,851
due to limited personnel equipment , 

1574
01:06:40,851 --> 01:06:43,073
transportation challenges and time . We 

1575
01:06:43,073 --> 01:06:45,073
had roughly 20 people to attempt to 

1576
01:06:45,073 --> 01:06:47,296
document the environmental exposures of 

1577
01:06:47,296 --> 01:06:49,610
over 37,000 people spread over an area 

1578
01:06:49,610 --> 01:06:52,180
roughly the size of Texas . However , I 

1579
01:06:52,180 --> 01:06:54,347
do not think more environmental health 

1580
01:06:54,347 --> 01:06:56,680
people are the ideal solution . The 

1581
01:06:56,680 --> 01:06:58,680
limited environmental health data , 

1582
01:06:58,680 --> 01:07:00,791
mostly air samples with some soil and 

1583
01:07:00,791 --> 01:07:02,791
water samples cannot be linked to a 

1584
01:07:02,791 --> 01:07:04,791
person but only to a location . And 

1585
01:07:04,791 --> 01:07:06,791
even if the person can confirm that 

1586
01:07:06,791 --> 01:07:08,847
they were at that location , it does 

1587
01:07:08,847 --> 01:07:11,069
not mean they had that exposure . Their 

1588
01:07:11,069 --> 01:07:13,291
exposures could have been much worse or 

1589
01:07:13,291 --> 01:07:13,200
much better than the sample indicated . 

1590
01:07:13,780 --> 01:07:16,002
The D . O . D . Has this responsibility 

1591
01:07:16,002 --> 01:07:18,058
and must address it as industry will 

1592
01:07:18,058 --> 01:07:20,280
likely not do so they do not face these 

1593
01:07:20,280 --> 01:07:22,058
particular challenges . We have 

1594
01:07:22,058 --> 01:07:24,113
struggled in this space since desert 

1595
01:07:24,113 --> 01:07:26,113
storm and we must look at different 

1596
01:07:26,113 --> 01:07:27,947
options moving forward . We must 

1597
01:07:27,947 --> 01:07:30,113
leverage technology and address policy 

1598
01:07:30,113 --> 01:07:31,891
issues to fix these gaps . Some 

1599
01:07:31,891 --> 01:07:34,002
possible options to consider creation 

1600
01:07:34,002 --> 01:07:36,113
of a joint program . Executive office 

1601
01:07:36,113 --> 01:07:38,058
in order to focus the research and 

1602
01:07:38,058 --> 01:07:39,836
funding on environmental health 

1603
01:07:39,836 --> 01:07:41,836
surveillance while also providing a 

1604
01:07:41,836 --> 01:07:44,058
central location to hold responsible in 

1605
01:07:44,058 --> 01:07:46,224
the future To silicone bracelets could 

1606
01:07:46,224 --> 01:07:48,447
be provided to service members to track 

1607
01:07:48,447 --> 01:07:50,724
their exposures . As mentioned earlier . 

1608
01:07:50,724 --> 01:07:52,836
These have been shown to capture more 

1609
01:07:52,836 --> 01:07:55,002
than 1500 different chemical compounds 

1610
01:07:55,002 --> 01:07:56,724
and would allow us to mitigate 

1611
01:07:56,724 --> 01:07:58,558
exposures much sooner while also 

1612
01:07:58,558 --> 01:07:58,550
providing a service member with 

1613
01:07:58,550 --> 01:08:01,670
personal exposure data Research three 

1614
01:08:01,670 --> 01:08:03,726
Research and build a replacement for 

1615
01:08:03,726 --> 01:08:05,726
the silicone bracelet which provide 

1616
01:08:05,726 --> 01:08:07,892
near real time information on exposure 

1617
01:08:07,892 --> 01:08:10,700
and dose . For a service member . Four 

1618
01:08:10,700 --> 01:08:12,830
create a repository of frozen soil 

1619
01:08:12,830 --> 01:08:14,941
samples from each deployment location 

1620
01:08:14,941 --> 01:08:17,108
so they may be tested in the future as 

1621
01:08:17,108 --> 01:08:18,830
needed . When new concerns are 

1622
01:08:18,830 --> 01:08:21,750
identified , five improve the personnel 

1623
01:08:21,750 --> 01:08:23,660
reporting system so that each 

1624
01:08:23,670 --> 01:08:26,250
individual can be located rather than 

1625
01:08:26,250 --> 01:08:28,417
their unit headquarters , which may be 

1626
01:08:28,417 --> 01:08:30,639
hundreds of miles away from them . This 

1627
01:08:30,639 --> 01:08:32,806
will allow for individual exposures to 

1628
01:08:32,806 --> 01:08:34,861
be much more accurately documented . 

1629
01:08:34,861 --> 01:08:37,083
Six remote sensing should be researched 

1630
01:08:37,083 --> 01:08:38,917
to address gaps in environmental 

1631
01:08:38,917 --> 01:08:40,917
surveillance . This will be key for 

1632
01:08:40,917 --> 01:08:43,028
small teams operating in remote areas 

1633
01:08:43,028 --> 01:08:45,139
or dense urban environments which may 

1634
01:08:45,139 --> 01:08:44,790
never have an environmental health 

1635
01:08:44,790 --> 01:08:47,860
professional visit them seven . Further 

1636
01:08:47,860 --> 01:08:49,790
research biomarker monitoring to 

1637
01:08:49,790 --> 01:08:51,957
document exposures a person had during 

1638
01:08:51,957 --> 01:08:54,012
their deployment over their military 

1639
01:08:54,012 --> 01:08:56,270
career . Finally , eight educate 

1640
01:08:56,270 --> 01:08:58,690
leaders on the hazards of toxic toxic 

1641
01:08:58,690 --> 01:09:00,634
exposures and hold them if they're 

1642
01:09:00,634 --> 01:09:02,801
responsible , hold them responsible if 

1643
01:09:02,801 --> 01:09:04,912
they needlessly expose their people . 

1644
01:09:05,170 --> 01:09:07,114
Thank you for your time . Open any 

1645
01:09:07,114 --> 01:09:09,940
questions ? Thank you , Senator Tillis . 

1646
01:09:10,670 --> 01:09:13,650
Thank you all for being here . Um I 

1647
01:09:13,650 --> 01:09:15,872
guess you heard the testimony . I think 

1648
01:09:15,872 --> 01:09:18,039
most of you were in the room uh during 

1649
01:09:18,039 --> 01:09:21,340
the first panel . Um it sounds as if 

1650
01:09:21,350 --> 01:09:23,520
there is consensus on one of the 

1651
01:09:23,530 --> 01:09:25,363
questions that I brought up were 

1652
01:09:25,410 --> 01:09:28,410
individualized monitoring and sensors . 

1653
01:09:29,170 --> 01:09:32,760
But speaking for active duty miss 

1654
01:09:32,760 --> 01:09:34,927
Torres . I do a lot of work . I served 

1655
01:09:34,927 --> 01:09:37,093
on the V . A . Committee . We've got a 

1656
01:09:37,093 --> 01:09:36,960
lot of work to do and we're making 

1657
01:09:36,960 --> 01:09:39,290
progress and again I want to give 

1658
01:09:39,850 --> 01:09:42,017
Senator Gillibrand credit for focusing 

1659
01:09:42,017 --> 01:09:44,128
on that issue . We're gonna make more 

1660
01:09:44,128 --> 01:09:46,072
progress there . I'm sorry for the 

1661
01:09:46,072 --> 01:09:48,239
situation with your husband and uh for 

1662
01:09:48,239 --> 01:09:50,406
the others that you mentioned but with 

1663
01:09:50,406 --> 01:09:52,461
respect to what we need to do better 

1664
01:09:52,461 --> 01:09:56,290
upstream . Um where how 

1665
01:09:56,290 --> 01:10:00,210
would you judge the D . O . D . And and 

1666
01:10:00,220 --> 01:10:02,442
making a priority ? The priorities that 

1667
01:10:02,442 --> 01:10:04,664
you all have delineated in your opening 

1668
01:10:04,664 --> 01:10:06,887
comments . Where are they falling short 

1669
01:10:08,460 --> 01:10:12,270
to place ? You need a red means 

1670
01:10:12,270 --> 01:10:15,470
on weird . But my team applied for a 

1671
01:10:15,470 --> 01:10:17,692
congressional directed medical research 

1672
01:10:17,692 --> 01:10:19,930
program grant funded by the D . O . D . 

1673
01:10:19,940 --> 01:10:21,890
Recently months ago we got a great 

1674
01:10:21,890 --> 01:10:25,270
score . This was for a monitor the size 

1675
01:10:25,270 --> 01:10:27,381
of a beeper that a soldier could wear 

1676
01:10:27,381 --> 01:10:29,326
would not only measure particulate 

1677
01:10:29,326 --> 01:10:31,492
matter but even sarin gas specifically 

1678
01:10:31,492 --> 01:10:34,330
and gunshot sounds . And despite a good 

1679
01:10:34,330 --> 01:10:36,441
score they said they're no fun . So I 

1680
01:10:36,441 --> 01:10:38,441
don't know why they're asking us to 

1681
01:10:38,441 --> 01:10:40,608
apply for grants if there's no money . 

1682
01:10:41,160 --> 01:10:43,216
Well that's a question we can get to 

1683
01:10:43,216 --> 01:10:46,920
the bottom of thank you senator . 

1684
01:10:46,930 --> 01:10:50,040
Um One of the biggest things that and I 

1685
01:10:50,040 --> 01:10:52,262
mentioned in the testimony . But one of 

1686
01:10:52,262 --> 01:10:53,929
the biggest problems is we've 

1687
01:10:53,929 --> 01:10:56,040
experience a big lack of transparency 

1688
01:10:56,040 --> 01:10:58,100
from federal agencies on what people 

1689
01:10:58,100 --> 01:10:59,930
were exposed to and on their 

1690
01:10:59,930 --> 01:11:02,097
deployments . That's the big thing and 

1691
01:11:02,097 --> 01:11:04,319
that's I think that the island is meant 

1692
01:11:04,319 --> 01:11:06,486
to tackle that . It's just a matter of 

1693
01:11:06,486 --> 01:11:08,708
is it going to be useful to the service 

1694
01:11:08,708 --> 01:11:10,930
member into the veteran ? That's that's 

1695
01:11:10,930 --> 01:11:13,041
key . You also mentioned the the idea 

1696
01:11:13,041 --> 01:11:15,400
that the registry is available . But I 

1697
01:11:15,400 --> 01:11:17,511
for one think that we should be in an 

1698
01:11:17,511 --> 01:11:19,678
opt out position that everybody should 

1699
01:11:19,678 --> 01:11:21,733
be registered in the registry and if 

1700
01:11:21,733 --> 01:11:23,733
they want to explicitly opt out , I 

1701
01:11:23,733 --> 01:11:25,733
suppose they should , but we should 

1702
01:11:25,733 --> 01:11:27,678
probably flip the script on that . 

1703
01:11:27,678 --> 01:11:29,844
Would you agree ? Right . The burn pit 

1704
01:11:29,844 --> 01:11:31,622
registry , it's um what the law 

1705
01:11:31,622 --> 01:11:33,844
requires is for them to be entered into 

1706
01:11:33,844 --> 01:11:36,011
it unless they opt not to so that it's 

1707
01:11:36,011 --> 01:11:38,122
not mandatory if you don't want to be 

1708
01:11:38,122 --> 01:11:40,344
in the registry . But the law says that 

1709
01:11:40,344 --> 01:11:42,250
if somebody is exposed or they're 

1710
01:11:42,260 --> 01:11:44,730
stationed next to a burn pit , then 

1711
01:11:44,740 --> 01:11:46,620
they should be entered into the 

1712
01:11:46,620 --> 01:11:50,320
registry . I agree . I 

1713
01:11:50,320 --> 01:11:52,910
mean the burn pit registry still falls 

1714
01:11:52,910 --> 01:11:55,077
short in so many ways . It's basically 

1715
01:11:55,077 --> 01:11:57,550
just self reported data that you could 

1716
01:11:57,550 --> 01:11:59,717
print out and carry around . But it is 

1717
01:11:59,717 --> 01:12:01,620
important that everyone be a 

1718
01:12:01,620 --> 01:12:04,690
participant of that effort . Um you 

1719
01:12:04,690 --> 01:12:06,690
know , they don't track mortality , 

1720
01:12:06,690 --> 01:12:08,746
which is I think one area that we've 

1721
01:12:08,746 --> 01:12:10,968
talked about for years . Doctors Emma . 

1722
01:12:10,968 --> 01:12:13,134
Um but I I agree . Senator Tillis said 

1723
01:12:13,134 --> 01:12:15,580
that should be mandated . Mr patterson 

1724
01:12:17,350 --> 01:12:19,910
senator , there's there's so many 

1725
01:12:19,910 --> 01:12:23,060
challenges in this space ? Uh , the 

1726
01:12:23,070 --> 01:12:25,292
previous individuals talking so much of 

1727
01:12:25,292 --> 01:12:28,260
it is self reported . So a 20 year old 

1728
01:12:28,260 --> 01:12:30,720
individual returns from overseas and 

1729
01:12:30,720 --> 01:12:32,887
you ask them what happened to him over 

1730
01:12:32,887 --> 01:12:35,790
15 months . And and that that that's 

1731
01:12:35,800 --> 01:12:39,190
just and not to mention the fact that 

1732
01:12:39,190 --> 01:12:41,960
that individual doesn't , they're not 

1733
01:12:41,960 --> 01:12:44,071
gonna be able to say I was exposed to 

1734
01:12:44,071 --> 01:12:47,730
TC or benzene or thylacine . Just some 

1735
01:12:47,730 --> 01:12:49,897
bad stuff happened to me . There was a 

1736
01:12:49,897 --> 01:12:52,260
lot of smoke . They can't say anything 

1737
01:12:52,260 --> 01:12:54,530
that is going to help that clinician 

1738
01:12:54,560 --> 01:12:56,838
when they end up in the V . A . System . 

1739
01:12:57,650 --> 01:13:00,670
So , so much of what is being done now 

1740
01:13:01,050 --> 01:13:04,170
is just not terribly effective . No , 

1741
01:13:04,170 --> 01:13:06,710
that's why I get to the need for us to 

1742
01:13:06,720 --> 01:13:09,290
get down to the atomic level uh , 

1743
01:13:09,300 --> 01:13:11,411
sooner rather than later . That's the 

1744
01:13:11,411 --> 01:13:13,578
only way we're really going to be able 

1745
01:13:13,578 --> 01:13:15,689
to capture it and then have the level 

1746
01:13:15,689 --> 01:13:17,633
of specificity with respect to the 

1747
01:13:17,633 --> 01:13:19,689
specific exposures . Um , so I agree 

1748
01:13:19,689 --> 01:13:22,060
with you all where coming up on the end 

1749
01:13:22,060 --> 01:13:24,171
of a vote . I thank you all for being 

1750
01:13:24,171 --> 01:13:26,282
here . I also appreciate your opening 

1751
01:13:26,282 --> 01:13:28,060
testimony . There were a lot of 

1752
01:13:28,060 --> 01:13:30,227
priorities put in there and they'll be 

1753
01:13:30,227 --> 01:13:32,393
instructive to me as we move forward . 

1754
01:13:32,393 --> 01:13:34,560
Thank you . Thank you Mr Chair . Thank 

1755
01:13:34,560 --> 01:13:36,671
you . Um mr Torres . First of all , I 

1756
01:13:36,671 --> 01:13:38,838
want to thank you for your advocacy on 

1757
01:13:38,838 --> 01:13:40,893
behalf of service members , veterans 

1758
01:13:40,893 --> 01:13:40,740
and their families who have suffered 

1759
01:13:40,740 --> 01:13:43,080
debilitating injuries and effects of 

1760
01:13:43,080 --> 01:13:46,240
burn pits . What is the top challenge 

1761
01:13:46,240 --> 01:13:48,351
that you hear from soldiers when they 

1762
01:13:48,351 --> 01:13:50,518
return from deployment about accessing 

1763
01:13:50,518 --> 01:13:53,730
about accessing treatment ? Well , 

1764
01:13:53,740 --> 01:13:56,540
first of all , Senator , thank you for 

1765
01:13:56,540 --> 01:13:59,370
having me um lots of challenges . You 

1766
01:13:59,370 --> 01:14:01,537
know , that question just brings up so 

1767
01:14:01,537 --> 01:14:04,380
many ideas in my mind of things that 

1768
01:14:04,380 --> 01:14:06,213
we've tracked through our own uh 

1769
01:14:06,213 --> 01:14:09,060
private registry . Um And off the top 

1770
01:14:09,060 --> 01:14:11,350
of my head it's you know , access to to 

1771
01:14:11,350 --> 01:14:13,239
healthcare monitoring specialized 

1772
01:14:13,239 --> 01:14:15,461
healthcare , both on on the D . O . D . 

1773
01:14:15,461 --> 01:14:17,739
M . V . A . Side , but primarily D . O . 

1774
01:14:17,739 --> 01:14:19,794
D . For those active service members 

1775
01:14:19,794 --> 01:14:22,440
for those reservists . It's a challenge 

1776
01:14:22,650 --> 01:14:26,520
when when they don't have uh trained 

1777
01:14:26,530 --> 01:14:29,350
occupational medicine doctors assessing 

1778
01:14:29,350 --> 01:14:32,040
these underlying issues . Um And then 

1779
01:14:32,040 --> 01:14:35,560
secondly is is filing for presumption 

1780
01:14:35,940 --> 01:14:37,990
for these illnesses that that are 

1781
01:14:37,990 --> 01:14:40,212
underlying right ? So if you don't have 

1782
01:14:40,212 --> 01:14:42,268
the specialized healthcare , how can 

1783
01:14:42,268 --> 01:14:44,850
they properly transition them through 

1784
01:14:44,860 --> 01:14:47,670
the compensation and disability process ? 

1785
01:14:48,040 --> 01:14:50,560
Alright , well thank you . Um What 

1786
01:14:50,560 --> 01:14:52,782
information and resources would be most 

1787
01:14:52,782 --> 01:14:55,004
helpful to the service members you work 

1788
01:14:55,004 --> 01:14:57,116
with when they return from deployment 

1789
01:14:57,116 --> 01:14:59,338
to ensure they're getting the screening 

1790
01:14:59,338 --> 01:15:01,560
and treatment they need . I think , you 

1791
01:15:01,560 --> 01:15:04,350
know , definitely make mandating that 

1792
01:15:04,350 --> 01:15:06,461
the clinicians be trained and I think 

1793
01:15:06,461 --> 01:15:08,628
doctors Emma can help me here . But um 

1794
01:15:08,628 --> 01:15:11,230
absolutely . Having every clinician , 

1795
01:15:11,230 --> 01:15:13,370
every nurse trained in the area of 

1796
01:15:13,370 --> 01:15:16,510
airborne hazards uh documenting in the 

1797
01:15:16,510 --> 01:15:18,810
record , you know , in the electronic 

1798
01:15:18,810 --> 01:15:20,866
health record in the V . A . And you 

1799
01:15:20,866 --> 01:15:24,340
decide that they are identified as 

1800
01:15:24,350 --> 01:15:26,340
having had undergone some type of 

1801
01:15:26,340 --> 01:15:29,750
exposure . Um and you know to say the 

1802
01:15:29,750 --> 01:15:31,694
least . I've had this conversation 

1803
01:15:31,694 --> 01:15:34,860
recently uh with with many people about 

1804
01:15:36,140 --> 01:15:38,900
even just something as small as signage 

1805
01:15:38,910 --> 01:15:40,966
right ? Like during during the World 

1806
01:15:40,966 --> 01:15:43,077
Trade Center . Uh there was there was 

1807
01:15:43,077 --> 01:15:45,370
communication and outreach and signage 

1808
01:15:45,370 --> 01:15:47,259
on if you were experiencing these 

1809
01:15:47,259 --> 01:15:50,470
issues . Um you know people are are 

1810
01:15:50,470 --> 01:15:52,740
having to access care through people 

1811
01:15:52,740 --> 01:15:54,907
like doctors Emma and they have to fly 

1812
01:15:54,907 --> 01:15:57,018
to new york and fly to Vanderbilt and 

1813
01:15:57,018 --> 01:15:59,240
fly and exhaust their life savings like 

1814
01:15:59,240 --> 01:16:01,462
our family did that that that shouldn't 

1815
01:16:01,462 --> 01:16:03,573
be happening in America and and so we 

1816
01:16:03,573 --> 01:16:05,796
we need to start and we can start now . 

1817
01:16:05,796 --> 01:16:09,560
Thank you very much . Um uh 

1818
01:16:09,570 --> 01:16:12,070
Mr Porter . Um thank you for sharing 

1819
01:16:12,070 --> 01:16:14,126
the survey results of your members . 

1820
01:16:14,126 --> 01:16:16,960
Why do you think only 59% of I A . V . 

1821
01:16:16,960 --> 01:16:19,016
A members are registered in the burn 

1822
01:16:19,016 --> 01:16:21,410
pits registry . Dr ross testified as to 

1823
01:16:21,410 --> 01:16:23,466
some of the steps the D . O . D . Is 

1824
01:16:23,466 --> 01:16:25,688
taking to increase participation in the 

1825
01:16:25,688 --> 01:16:27,910
registry . Have you seen an increase in 

1826
01:16:27,910 --> 01:16:30,021
those registered over the years among 

1827
01:16:30,021 --> 01:16:32,077
your members ? And what do you think 

1828
01:16:32,077 --> 01:16:34,132
can be done to better encourage more 

1829
01:16:34,132 --> 01:16:33,550
service members and veterans to 

1830
01:16:33,550 --> 01:16:36,050
participate ? Thank you for the 

1831
01:16:36,060 --> 01:16:39,030
question . Um this we started this came 

1832
01:16:39,030 --> 01:16:40,974
up when we developed the burn pits 

1833
01:16:40,974 --> 01:16:43,141
accountability after a few years ago . 

1834
01:16:43,141 --> 01:16:45,252
Um because if you look on the V . A . 

1835
01:16:45,252 --> 01:16:47,474
website it has a running total of those 

1836
01:16:47,474 --> 01:16:49,641
that are registered in it . And at the 

1837
01:16:49,641 --> 01:16:53,560
time when we looked at it back in 2017 

1838
01:16:53,730 --> 01:16:56,970
There was only 140,000 entries into the 

1839
01:16:56,970 --> 01:16:59,192
registry . I think it's probably double 

1840
01:16:59,192 --> 01:17:01,248
that now . I haven't looked recently 

1841
01:17:01,248 --> 01:17:03,303
here . Um but it was only 100 40,000 

1842
01:17:03,303 --> 01:17:05,081
and that's out of again via his 

1843
01:17:05,081 --> 01:17:08,370
estimate is as many as 3.5 million have 

1844
01:17:08,370 --> 01:17:10,990
been exposed . Um so for only 100 and 

1845
01:17:10,990 --> 01:17:13,212
40,000 that presented a big challenge . 

1846
01:17:13,212 --> 01:17:15,460
I think that the the main problem with 

1847
01:17:15,460 --> 01:17:17,682
that was that the reason for that is is 

1848
01:17:17,682 --> 01:17:19,849
because hardly anybody knows about the 

1849
01:17:19,849 --> 01:17:22,660
registry . Uh So through the passage of 

1850
01:17:22,660 --> 01:17:24,716
that bill , we talked about it a lot 

1851
01:17:24,716 --> 01:17:27,010
and we put it on a lot of social media 

1852
01:17:27,010 --> 01:17:29,232
on that . And we've also encouraged the 

1853
01:17:29,232 --> 01:17:31,288
V . A . To do more about that to get 

1854
01:17:31,288 --> 01:17:33,232
the word out to veterans that this 

1855
01:17:33,232 --> 01:17:35,399
registry is here and then why somebody 

1856
01:17:35,399 --> 01:17:37,121
should be in it . Um You get I 

1857
01:17:37,121 --> 01:17:39,343
understand a free health exam if you're 

1858
01:17:39,343 --> 01:17:42,750
in the system . Um but again , it's not 

1859
01:17:43,330 --> 01:17:45,663
qualifying . Somebody for a presumption , 

1860
01:17:45,663 --> 01:17:47,608
I think there's a misunderstanding 

1861
01:17:47,608 --> 01:17:49,719
there too . Uh That's veterans should 

1862
01:17:49,719 --> 01:17:51,860
apply for the for their their 

1863
01:17:51,870 --> 01:17:53,981
disability and they're getting turned 

1864
01:17:53,981 --> 01:17:56,430
down about three quarters of the people 

1865
01:17:56,430 --> 01:17:58,610
that apply you testified that the 

1866
01:17:58,610 --> 01:18:00,570
island's system that if the island 

1867
01:18:00,570 --> 01:18:02,737
system is done right ? Service members 

1868
01:18:02,737 --> 01:18:04,681
and veterans will have significant 

1869
01:18:04,681 --> 01:18:06,903
transparency into their exposure . What 

1870
01:18:06,903 --> 01:18:08,959
does done right mean to you and what 

1871
01:18:08,959 --> 01:18:11,070
are the critical components of island 

1872
01:18:11,070 --> 01:18:10,370
that must be implemented to make a 

1873
01:18:10,380 --> 01:18:12,600
difference in the care service members 

1874
01:18:12,600 --> 01:18:15,440
and veterans receive ? Well , what 

1875
01:18:15,440 --> 01:18:17,850
right looks like is it 

1876
01:18:19,220 --> 01:18:22,440
If somebody was deployed to Balad Iraq 

1877
01:18:22,450 --> 01:18:25,930
in 2006 , then that Eyler 

1878
01:18:25,940 --> 01:18:29,000
should be able to give them the data 

1879
01:18:29,000 --> 01:18:31,320
from what they were probably exposed to 

1880
01:18:31,330 --> 01:18:34,600
in 2006 and ballot same thing with me . 

1881
01:18:34,610 --> 01:18:37,420
Um I traveled around Afghanistan , all 

1882
01:18:37,420 --> 01:18:39,642
over the place so it really couldn't be 

1883
01:18:39,642 --> 01:18:41,864
pinpoint to one location . So that just 

1884
01:18:41,864 --> 01:18:43,830
shows how complex it was . Um So I 

1885
01:18:43,830 --> 01:18:45,719
traveled around the whole country 

1886
01:18:45,719 --> 01:18:47,886
frequently . Um so it'll be harder for 

1887
01:18:47,886 --> 01:18:49,941
that . But again , it should specify 

1888
01:18:49,941 --> 01:18:52,120
what you're exposed to during your 

1889
01:18:52,120 --> 01:18:54,398
deployment during a set period of time . 

1890
01:18:54,820 --> 01:18:56,764
Um Now I'm gonna turn over Senator 

1891
01:18:56,764 --> 01:18:58,764
Warren and she's going to chair the 

1892
01:18:58,764 --> 01:19:02,580
meeting while I go vote . So thank 

1893
01:19:02,580 --> 01:19:05,230
you . We're tag teaming here . I voted 

1894
01:19:05,240 --> 01:19:08,160
early so that I could I could be here 

1895
01:19:08,720 --> 01:19:11,760
while the chairwoman goes to vote and I 

1896
01:19:11,770 --> 01:19:14,290
want to say publicly , Big thank you to 

1897
01:19:14,290 --> 01:19:17,180
the chairwoman for holding this hearing . 

1898
01:19:17,180 --> 01:19:19,402
I think it's really important . I think 

1899
01:19:19,402 --> 01:19:22,240
it's important that this committee 

1900
01:19:22,240 --> 01:19:24,890
looked at the real costs of war 

1901
01:19:24,900 --> 01:19:27,230
including where the Department of 

1902
01:19:27,230 --> 01:19:30,450
Defense failed to take steps that were 

1903
01:19:30,450 --> 01:19:33,580
necessary to prevent exposing members 

1904
01:19:33,580 --> 01:19:36,250
of the military to toxic chemicals . I 

1905
01:19:36,250 --> 01:19:38,472
know that many of our witnesses on this 

1906
01:19:38,472 --> 01:19:40,472
panel have been fighting for over a 

1907
01:19:40,472 --> 01:19:43,350
decade for D . O . D . And the V . A . 

1908
01:19:43,350 --> 01:19:47,240
To recognize how burn pit exposure 

1909
01:19:47,620 --> 01:19:50,610
has had devastating effects on service 

1910
01:19:50,610 --> 01:19:53,190
members lives . Now I know that there 

1911
01:19:53,190 --> 01:19:56,310
is some debate over the data but it's 

1912
01:19:56,310 --> 01:20:00,060
just common sense that these toxins 

1913
01:20:00,060 --> 01:20:02,240
would cause significant problems to 

1914
01:20:02,240 --> 01:20:05,820
human beings and it's important for dod 

1915
01:20:05,820 --> 01:20:08,480
to continue to study this issue , to 

1916
01:20:08,480 --> 01:20:10,313
improve our understanding of the 

1917
01:20:10,313 --> 01:20:13,370
science . But we can't keep waiting for 

1918
01:20:13,380 --> 01:20:16,200
action . We need to take care of our 

1919
01:20:16,200 --> 01:20:20,150
veterans . Now , not later now I 

1920
01:20:20,150 --> 01:20:22,610
know that the focus of today's hearing 

1921
01:20:22,620 --> 01:20:25,910
is diodes role in determining 

1922
01:20:25,920 --> 01:20:29,410
eligibility for care . Not the VHS but 

1923
01:20:29,410 --> 01:20:31,980
we also have to consider the toll of 

1924
01:20:31,980 --> 01:20:35,610
this entire process on families . So MS 

1925
01:20:35,610 --> 01:20:37,777
Torres if you don't mind , I'd like to 

1926
01:20:37,777 --> 01:20:40,260
be able to ask you about your 

1927
01:20:40,260 --> 01:20:43,990
experiences . I read your testimony , I 

1928
01:20:44,000 --> 01:20:47,990
understand um about how hard you've 

1929
01:20:47,990 --> 01:20:50,410
had to fight , how long you have had to 

1930
01:20:50,410 --> 01:20:54,280
fight to get the care that your husband 

1931
01:20:54,280 --> 01:20:56,180
deserves and that other veterans 

1932
01:20:56,180 --> 01:20:59,630
deserve . So if I can let me just ask 

1933
01:20:59,630 --> 01:21:03,530
you a little bit about how this process 

1934
01:21:04,110 --> 01:21:08,100
make sure family feel . Thank 

1935
01:21:08,100 --> 01:21:10,100
you so much for for that question . 

1936
01:21:10,610 --> 01:21:12,790
It's been it's been a journey , a 

1937
01:21:12,800 --> 01:21:16,080
hellish journey of of delay and deny 

1938
01:21:16,090 --> 01:21:18,257
not just for myself the tourist family 

1939
01:21:18,257 --> 01:21:20,700
but for thousands , possibly millions 

1940
01:21:20,700 --> 01:21:24,100
of families . Um it feels I know for my 

1941
01:21:24,100 --> 01:21:26,780
husband being stripped of his integrity 

1942
01:21:26,780 --> 01:21:29,920
and dignity , you know , losing his job . 

1943
01:21:29,930 --> 01:21:32,420
Um , you know , being on the brink of 

1944
01:21:32,420 --> 01:21:35,170
foreclosure repossession of cars . And 

1945
01:21:35,170 --> 01:21:37,630
you ask yourself , how did we get here 

1946
01:21:37,640 --> 01:21:39,807
and how is this happening in America's 

1947
01:21:39,807 --> 01:21:42,610
backyard ? It feels as if the nation 

1948
01:21:42,610 --> 01:21:45,300
has turned its back when you're , you 

1949
01:21:45,300 --> 01:21:48,660
know , attempting to just access care . 

1950
01:21:48,670 --> 01:21:51,340
We we we we attempted to access care 

1951
01:21:51,350 --> 01:21:53,260
from both D . O . D . And V . A . 

1952
01:21:53,260 --> 01:21:55,400
Healthcare institutions . And 

1953
01:21:55,400 --> 01:21:57,470
throughout those 10 years , it was 

1954
01:21:57,470 --> 01:21:59,910
always an excuse of , there's no 

1955
01:21:59,910 --> 01:22:02,870
science , there's no proof . And so 

1956
01:22:02,880 --> 01:22:05,260
myself , including I know many , many 

1957
01:22:05,260 --> 01:22:08,490
families maybe to include yours tom is 

1958
01:22:08,490 --> 01:22:10,460
that we have to exhaust our life 

1959
01:22:10,460 --> 01:22:13,370
savings just to access doctors like dr 

1960
01:22:13,370 --> 01:22:16,110
Anthony zima like dr robert miller , 

1961
01:22:16,600 --> 01:22:18,489
like the doctors over at national 

1962
01:22:18,489 --> 01:22:20,980
jewish being away from our Children . 

1963
01:22:20,990 --> 01:22:23,046
That's time lost that I'll never get 

1964
01:22:23,046 --> 01:22:25,880
back . And so not only , you know , 

1965
01:22:25,890 --> 01:22:27,870
does it impact the veteran and the 

1966
01:22:27,870 --> 01:22:31,120
spouse , but the Children and so you 

1967
01:22:31,120 --> 01:22:33,990
know , to to still to this day to 

1968
01:22:33,990 --> 01:22:35,934
finally see some momentum as we're 

1969
01:22:35,934 --> 01:22:38,410
seeing now , um , it really gives us 

1970
01:22:38,410 --> 01:22:40,750
hope . Well , I'm , I'm glad to hear 

1971
01:22:40,750 --> 01:22:44,740
you in that on hope . But when you say , 

1972
01:22:44,740 --> 01:22:47,920
you feel as if our government , 

1973
01:22:48,400 --> 01:22:51,510
our country has turned its back 

1974
01:22:52,200 --> 01:22:55,640
on you and your family and thousands , 

1975
01:22:55,640 --> 01:22:57,910
maybe millions of families in the same 

1976
01:22:57,910 --> 01:23:00,132
position . No veterans should feel that 

1977
01:23:00,132 --> 01:23:03,340
way . Uh , and no family of the 

1978
01:23:03,340 --> 01:23:05,930
veterans should feel that way . Um , 

1979
01:23:05,940 --> 01:23:08,600
you have done a tremendous amount of 

1980
01:23:08,610 --> 01:23:11,840
advocacy related to changing the rules 

1981
01:23:11,840 --> 01:23:14,300
for how veterans must prove they were 

1982
01:23:14,310 --> 01:23:17,620
impacted by burn pits in order to get 

1983
01:23:17,630 --> 01:23:21,090
care . I support you in your work on 

1984
01:23:21,090 --> 01:23:24,710
this . I know it is a hard and lonely 

1985
01:23:24,710 --> 01:23:27,190
journey , but you have done remarkable 

1986
01:23:27,190 --> 01:23:29,620
work here . So let me see if I can turn 

1987
01:23:29,620 --> 01:23:31,960
this around just a little bit . MS 

1988
01:23:31,960 --> 01:23:34,740
Torres , what would it mean to you and 

1989
01:23:34,750 --> 01:23:37,900
other veterans families if the rules 

1990
01:23:37,900 --> 01:23:41,500
were changed ? So that the D . A . I'm 

1991
01:23:41,500 --> 01:23:43,722
sorry . So that the D . O . D . And the 

1992
01:23:43,722 --> 01:23:46,730
V . A . Believed veterans when they 

1993
01:23:46,730 --> 01:23:48,860
said their health was harmed by burn 

1994
01:23:48,860 --> 01:23:51,850
pits rather than making them jump 

1995
01:23:52,020 --> 01:23:55,300
through so many hoops . Well it would 

1996
01:23:55,300 --> 01:23:57,590
it would remove the burden of proof of 

1997
01:23:57,590 --> 01:24:01,150
us having to be our own lawyers , our 

1998
01:24:01,150 --> 01:24:03,570
own researchers , our own all of those 

1999
01:24:03,570 --> 01:24:06,240
things that we've become right . We've 

2000
01:24:06,240 --> 01:24:09,700
we've sort of , you know , mobilized 

2001
01:24:10,090 --> 01:24:13,830
and congregated online , all sharing 

2002
01:24:13,830 --> 01:24:15,900
that common denominator of delay and 

2003
01:24:15,900 --> 01:24:19,100
deny . So to finally see , you know , 

2004
01:24:19,100 --> 01:24:21,267
historic legislation passed so that we 

2005
01:24:21,267 --> 01:24:23,322
don't have to be all those things so 

2006
01:24:23,322 --> 01:24:26,830
that the Gold star spouses that call us 

2007
01:24:27,490 --> 01:24:30,400
weekly expressing how heart wrenching 

2008
01:24:30,400 --> 01:24:33,000
it is for them to spend the last 

2009
01:24:33,000 --> 01:24:34,889
moments of their loved one's life 

2010
01:24:34,889 --> 01:24:37,920
gathering buddy statements and evidence 

2011
01:24:38,290 --> 01:24:40,346
when they should be holding the hand 

2012
01:24:40,346 --> 01:24:42,960
and and and embracing their loved one . 

2013
01:24:42,970 --> 01:24:45,300
Um , it would mean it would mean 

2014
01:24:45,300 --> 01:24:47,200
everything to to us and to those 

2015
01:24:47,200 --> 01:24:49,311
families that are still struggling to 

2016
01:24:49,311 --> 01:24:51,533
this day and for those still waiting on 

2017
01:24:51,533 --> 01:24:54,250
an answer from the V . A . Well , as I 

2018
01:24:54,250 --> 01:24:56,730
said , I commend you for your advocacy 

2019
01:24:56,730 --> 01:25:00,510
work here . Uh it at least helps us 

2020
01:25:00,510 --> 01:25:02,680
start to move in the right direction . 

2021
01:25:02,690 --> 01:25:06,250
And I appreciate that making a change 

2022
01:25:06,250 --> 01:25:09,260
like this is not inexpensive . There's 

2023
01:25:09,260 --> 01:25:12,390
a lot of money at stake here . And I 

2024
01:25:12,390 --> 01:25:14,446
also understand it is not all in the 

2025
01:25:14,446 --> 01:25:17,960
jurisdiction of this committee , but it 

2026
01:25:17,960 --> 01:25:21,580
is urgent that we treat families , we 

2027
01:25:21,580 --> 01:25:24,150
treat those who are injured without 

2028
01:25:24,150 --> 01:25:27,990
delay . We cannot allow veterans to 

2029
01:25:27,990 --> 01:25:30,810
wait another minute for healthcare . 

2030
01:25:31,290 --> 01:25:34,800
And so I I hope that the work we do 

2031
01:25:34,800 --> 01:25:38,230
here today will help put more momentum 

2032
01:25:38,240 --> 01:25:41,620
behind change at this committee 

2033
01:25:42,090 --> 01:25:45,300
regularly advocates for spending 

2034
01:25:45,790 --> 01:25:49,340
on weapons that don't work or 

2035
01:25:49,350 --> 01:25:53,230
weapons that are not needed at all . It 

2036
01:25:53,230 --> 01:25:57,230
is inexcusable to claim that we need to 

2037
01:25:57,230 --> 01:26:00,600
balance the budget on the backs of 

2038
01:26:00,610 --> 01:26:02,860
veterans and their families who have 

2039
01:26:02,870 --> 01:26:06,380
been injured . So I hope that what 

2040
01:26:06,380 --> 01:26:08,820
comes out of our work today is that we 

2041
01:26:08,820 --> 01:26:11,800
can we can give a stronger push on that . 

2042
01:26:12,380 --> 01:26:15,050
Um , if I can , I've got a few more 

2043
01:26:15,050 --> 01:26:17,820
questions here questions that the chair 

2044
01:26:17,830 --> 01:26:21,390
also wanted me to ask . Mr Patterson , 

2045
01:26:21,780 --> 01:26:24,470
If I could ask you about the advances 

2046
01:26:24,470 --> 01:26:28,290
in technology that have been made , uh , 

2047
01:26:28,290 --> 01:26:32,130
and can be made to improve the way that 

2048
01:26:32,140 --> 01:26:36,140
troops toxic exposure can be 

2049
01:26:36,140 --> 01:26:38,560
documented . Could you say a bit about 

2050
01:26:38,560 --> 01:26:41,930
that please ? Well , as far as well . 

2051
01:26:41,930 --> 01:26:44,097
Thank you senator . As far as advances 

2052
01:26:44,097 --> 01:26:46,097
since Desert Storm , sadly it's not 

2053
01:26:46,097 --> 01:26:48,520
been very significant . Uh , we we 

2054
01:26:48,520 --> 01:26:50,470
replaced the Minie ball with a 

2055
01:26:50,470 --> 01:26:52,192
different type of deployable , 

2056
01:26:52,192 --> 01:26:54,210
particularly matter sampler , but 

2057
01:26:54,210 --> 01:26:56,510
there's still significant challenges . 

2058
01:26:56,550 --> 01:26:58,439
Those samplers simply capture the 

2059
01:26:58,439 --> 01:27:00,661
particular matter that's in the air and 

2060
01:27:00,661 --> 01:27:02,828
then you can send it to a lab and many 

2061
01:27:02,828 --> 01:27:05,660
months later get a report back of of 

2062
01:27:05,660 --> 01:27:08,810
what was possibly in that sample . The 

2063
01:27:08,820 --> 01:27:10,653
downside of that is any volatile 

2064
01:27:10,653 --> 01:27:12,764
organic compounds are not going to be 

2065
01:27:12,764 --> 01:27:15,390
in that sample because they have cooked 

2066
01:27:15,390 --> 01:27:17,540
off in the transportation and those 

2067
01:27:17,540 --> 01:27:19,890
months for you to get the sample back . 

2068
01:27:20,580 --> 01:27:23,770
So the progress has been extremely 

2069
01:27:23,770 --> 01:27:27,270
slow and extremely challenging . And 

2070
01:27:27,270 --> 01:27:29,270
I'm just looking at my time in from 

2071
01:27:29,270 --> 01:27:32,130
Desert Storm to Afghanistan . 

2072
01:27:32,140 --> 01:27:34,680
Um , I made some recommendations 

2073
01:27:34,690 --> 01:27:38,430
recommendations in my testimony . I 

2074
01:27:38,430 --> 01:27:40,541
believe that the biomarkers have some 

2075
01:27:40,541 --> 01:27:43,400
significant capabilities with them . 

2076
01:27:44,350 --> 01:27:46,461
The silicone bracelets . I think it's 

2077
01:27:46,461 --> 01:27:48,683
an excellent idea because then we would 

2078
01:27:48,683 --> 01:27:51,450
be able to know much sooner . For 

2079
01:27:51,450 --> 01:27:53,228
instance , Afghanistan , we had 

2080
01:27:53,228 --> 01:27:55,394
formaldehyde treated lumber from china 

2081
01:27:55,394 --> 01:27:57,506
that we were using to build the small 

2082
01:27:57,506 --> 01:27:59,672
buildings that the soldiers slept in . 

2083
01:27:59,672 --> 01:28:01,561
I had no reason to expect to find 

2084
01:28:01,561 --> 01:28:04,240
formaldehyde in a pristine river valley 

2085
01:28:04,240 --> 01:28:06,290
in Afghanistan . What ? Why is that 

2086
01:28:06,300 --> 01:28:08,860
there ? I have no reason to go look for 

2087
01:28:08,860 --> 01:28:11,180
that . If we had had those silicone 

2088
01:28:11,180 --> 01:28:13,320
bracelets on those individuals , we 

2089
01:28:13,320 --> 01:28:15,376
could have had them back and there's 

2090
01:28:15,376 --> 01:28:17,730
there's time to this ? But I would have 

2091
01:28:17,730 --> 01:28:20,650
known quickly rather than a year or two 

2092
01:28:20,650 --> 01:28:23,630
later . Why ? Why ? What is this ? And 

2093
01:28:23,630 --> 01:28:25,741
then we could have mitigated it and I 

2094
01:28:25,741 --> 01:28:27,908
could have protected the next group of 

2095
01:28:27,908 --> 01:28:30,074
soldiers that went in there . So , and 

2096
01:28:30,074 --> 01:28:32,352
in the remote sensing that I mentioned , 

2097
01:28:32,352 --> 01:28:34,680
I believe is very key moving forward 

2098
01:28:34,680 --> 01:28:36,624
when we get to , if we're gonna do 

2099
01:28:36,624 --> 01:28:38,902
dispersed operations with small groups , 

2100
01:28:39,270 --> 01:28:41,381
there's a lot of atmospheric analysis 

2101
01:28:41,381 --> 01:28:43,437
that can be done with with satellite 

2102
01:28:43,437 --> 01:28:45,570
imagery . It's a bit of an immature 

2103
01:28:45,570 --> 01:28:49,130
space . But if you're talking special 

2104
01:28:49,130 --> 01:28:51,590
operations units that are very small , 

2105
01:28:51,610 --> 01:28:53,840
they're never gonna have a preventive 

2106
01:28:53,840 --> 01:28:57,100
medicine person visit them . So that 

2107
01:28:57,100 --> 01:29:00,570
would give you some idea and I believe 

2108
01:29:00,570 --> 01:29:03,100
the problem with all of these things is 

2109
01:29:03,870 --> 01:29:06,160
they're not perfect , but they will 

2110
01:29:06,160 --> 01:29:08,790
further the science significantly and 

2111
01:29:08,790 --> 01:29:10,734
we we've been pushing too much for 

2112
01:29:10,734 --> 01:29:14,180
perfect Rather than taking some 

2113
01:29:14,180 --> 01:29:16,530
reasonable steps forward . And just so 

2114
01:29:16,530 --> 01:29:19,170
I can get the comparison here , can you 

2115
01:29:19,170 --> 01:29:21,620
say a little bit about when you were in 

2116
01:29:21,620 --> 01:29:25,390
Afghanistan in 2008 and 2009 , how was 

2117
01:29:25,390 --> 01:29:28,960
an individual's exposure to a burn 

2118
01:29:28,960 --> 01:29:32,020
pit measured or documented ? Well , 

2119
01:29:32,030 --> 01:29:33,808
senator , some of them were not 

2120
01:29:33,808 --> 01:29:36,310
documented at all . Um , which which is 

2121
01:29:36,310 --> 01:29:39,200
a very frustrating point for me because 

2122
01:29:39,770 --> 01:29:41,850
we we were operating down into small 

2123
01:29:41,850 --> 01:29:44,072
fobs where it might have been a platoon 

2124
01:29:44,072 --> 01:29:46,072
on a fob . So 50 people , maybe 100 

2125
01:29:46,072 --> 01:29:49,190
individuals And with with the staff of 

2126
01:29:49,190 --> 01:29:51,860
approximately 20 people . There was no 

2127
01:29:51,860 --> 01:29:54,580
way that I could get them out there to 

2128
01:29:54,580 --> 01:29:57,080
do that surveillance , which should 

2129
01:29:57,080 --> 01:29:59,810
have been done weekly . I ideally you 

2130
01:29:59,810 --> 01:30:02,032
want to do it once a week rotating . So 

2131
01:30:02,032 --> 01:30:04,310
you never repeated on the same weekday . 

2132
01:30:05,260 --> 01:30:07,482
So some of those , some of those fobs , 

2133
01:30:07,482 --> 01:30:10,220
I would grab a soil sample because that 

2134
01:30:10,220 --> 01:30:12,580
was all that I could do . Those air 

2135
01:30:12,580 --> 01:30:15,160
monitors take 24 hours to capture a 

2136
01:30:15,160 --> 01:30:17,850
sample properly . If you just go and 

2137
01:30:17,850 --> 01:30:20,350
take a grab , it could be very high or 

2138
01:30:20,350 --> 01:30:22,820
very low . You need the average over 24 

2139
01:30:22,820 --> 01:30:26,450
hours . So a lot of them 

2140
01:30:26,480 --> 01:30:28,591
there's there's probably little to no 

2141
01:30:28,591 --> 01:30:30,780
data in the doors system which was 

2142
01:30:30,780 --> 01:30:33,460
mentioned earlier to be able to address 

2143
01:30:33,460 --> 01:30:35,730
that soldiers concerns the larger 

2144
01:30:35,730 --> 01:30:39,420
compounds fared better . But 

2145
01:30:39,430 --> 01:30:42,650
even then I I cannot tell you what I 

2146
01:30:42,650 --> 01:30:45,100
was exposed to in those 13 months and 

2147
01:30:45,100 --> 01:30:48,170
this was my job . So for an 

2148
01:30:48,170 --> 01:30:51,640
individual Who is ignorant of the space 

2149
01:30:51,640 --> 01:30:54,830
and thinks they're invulnerable at 20 

2150
01:30:54,830 --> 01:30:57,120
something . They're not going to have 

2151
01:30:57,120 --> 01:30:59,310
any idea . So let me just ask the 

2152
01:30:59,310 --> 01:31:01,630
follow on question two , that when 

2153
01:31:01,630 --> 01:31:04,630
service members are headed home , what 

2154
01:31:04,630 --> 01:31:06,810
kind of information were they given 

2155
01:31:06,820 --> 01:31:10,360
about their exposure and what kind of 

2156
01:31:10,360 --> 01:31:12,249
risks they might be facing in the 

2157
01:31:12,249 --> 01:31:15,750
future . It was all self 

2158
01:31:15,750 --> 01:31:19,530
reporting that I recall sometimes some 

2159
01:31:19,530 --> 01:31:21,474
units would put something in their 

2160
01:31:21,474 --> 01:31:24,650
medical record that said you you had a 

2161
01:31:24,650 --> 01:31:26,940
burn pit exposure or you had a heavy 

2162
01:31:26,940 --> 01:31:29,730
metal exposure from the location that 

2163
01:31:29,730 --> 01:31:32,450
you were in . But that was a unit by 

2164
01:31:32,450 --> 01:31:36,000
unit Situation . And , and then as 

2165
01:31:36,000 --> 01:31:38,170
mentioned earlier that they asked this 

2166
01:31:38,180 --> 01:31:42,030
20 year old invincible individual 

2167
01:31:42,040 --> 01:31:44,850
what were you exposed to ? I'm fine . I 

2168
01:31:44,850 --> 01:31:47,440
don't have any problems . And and they 

2169
01:31:47,450 --> 01:31:50,520
they move out another concern is then 

2170
01:31:50,520 --> 01:31:52,520
those individuals that never end up 

2171
01:31:52,520 --> 01:31:55,070
going to the V . A . At all . You did 

2172
01:31:55,070 --> 01:31:57,210
your tour , you were 22 years old and 

2173
01:31:57,210 --> 01:32:00,270
bulletproof . And and they never went 

2174
01:32:00,270 --> 01:32:02,870
into the v . A . system , Then they 

2175
01:32:02,880 --> 01:32:04,936
they approached the v . A . 10 or 20 

2176
01:32:04,936 --> 01:32:07,080
years later . Now they have that much 

2177
01:32:07,450 --> 01:32:11,090
of a tougher upstream fight and the fob 

2178
01:32:11,100 --> 01:32:12,878
that the compound names changed 

2179
01:32:12,878 --> 01:32:15,270
constantly . There are some individuals 

2180
01:32:15,270 --> 01:32:17,103
that probably you know that that 

2181
01:32:17,103 --> 01:32:20,380
compound no longer existed . Five years 

2182
01:32:20,380 --> 01:32:22,550
later , quite often they changed every 

2183
01:32:22,550 --> 01:32:25,720
year . Um the the gentleman talking 

2184
01:32:25,720 --> 01:32:27,720
about being able to link this to an 

2185
01:32:27,720 --> 01:32:30,040
individual's exposure unless the 

2186
01:32:30,040 --> 01:32:32,570
personnel operating system has changed 

2187
01:32:32,950 --> 01:32:36,280
that unit identification code links 

2188
01:32:36,280 --> 01:32:38,440
everybody to the usually the company 

2189
01:32:38,440 --> 01:32:40,980
level . But if that company operated 

2190
01:32:40,980 --> 01:32:43,920
three sites with their platoons broken 

2191
01:32:43,920 --> 01:32:47,060
out to those other sites , that data is 

2192
01:32:47,060 --> 01:32:49,760
not accurate for that individual . 

2193
01:32:50,850 --> 01:32:52,794
So there there's gonna be a lot of 

2194
01:32:52,794 --> 01:32:55,880
challenges And and the further we go 

2195
01:32:55,880 --> 01:32:58,880
back , the more challenges there are 

2196
01:32:58,880 --> 01:33:01,980
going to be with linking people to 

2197
01:33:01,980 --> 01:33:04,590
location to exposure . Thank you . 

2198
01:33:04,600 --> 01:33:07,180
Thank you very much . I'm gonna yield 

2199
01:33:07,190 --> 01:33:09,523
back to the chair . Thank you very much . 

2200
01:33:10,250 --> 01:33:12,528
Thank you all for your testimony today . 

2201
01:33:12,528 --> 01:33:14,583
I think you have really informed the 

2202
01:33:14,583 --> 01:33:17,390
committee um what we have to accomplish . 

2203
01:33:17,400 --> 01:33:19,860
I particularly appreciated the specific 

2204
01:33:19,860 --> 01:33:21,749
requests that you've made of this 

2205
01:33:21,749 --> 01:33:23,916
committee . Um specific changes in the 

2206
01:33:23,916 --> 01:33:26,082
law you'd like to see . Um The benefit 

2207
01:33:26,082 --> 01:33:27,860
of this committee is we are the 

2208
01:33:27,860 --> 01:33:30,027
personnel subcommittee so we can write 

2209
01:33:30,027 --> 01:33:32,082
these requirements into law next for 

2210
01:33:32,082 --> 01:33:34,193
this year's N . D . A . And so you've 

2211
01:33:34,193 --> 01:33:36,390
given us really good information about 

2212
01:33:36,400 --> 01:33:38,567
where the system is lacking , why it's 

2213
01:33:38,567 --> 01:33:40,622
not getting the data that it needs . 

2214
01:33:40,622 --> 01:33:42,733
How we actually collect the data . We 

2215
01:33:42,733 --> 01:33:44,920
really do need what's lacking in terms 

2216
01:33:44,920 --> 01:33:47,450
of when our our personnel are getting 

2217
01:33:47,450 --> 01:33:49,820
their medical exams and what the 

2218
01:33:49,820 --> 01:33:52,480
baseline is and what pre deployment and 

2219
01:33:52,480 --> 01:33:55,730
post employment look like . Um I don't 

2220
01:33:55,730 --> 01:33:57,786
know if this was addressed . But did 

2221
01:33:57,786 --> 01:34:00,180
did you guys discuss um how what is the 

2222
01:34:00,180 --> 01:34:02,110
best way to transfer the medical 

2223
01:34:02,110 --> 01:34:03,943
records from active duty service 

2224
01:34:03,943 --> 01:34:07,170
members to um veteran status and what 

2225
01:34:07,180 --> 01:34:09,347
you would like to see in that transfer 

2226
01:34:09,347 --> 01:34:11,470
of information and what we might need 

2227
01:34:11,470 --> 01:34:13,560
to create if we don't have it . 

2228
01:34:16,240 --> 01:34:18,296
Sure senator . It's that that should 

2229
01:34:18,296 --> 01:34:20,462
work with the electronic health record 

2230
01:34:20,462 --> 01:34:23,360
reform . So when that looks right which 

2231
01:34:23,360 --> 01:34:26,010
means a seamless transition from the D . 

2232
01:34:26,010 --> 01:34:28,220
O . D . To the V . A . And and that 

2233
01:34:28,220 --> 01:34:31,540
that service member or veteran can have 

2234
01:34:31,540 --> 01:34:34,060
easy access to that to that information 

2235
01:34:34,640 --> 01:34:38,040
and access to the island's system . And 

2236
01:34:38,040 --> 01:34:40,096
on that point Senator . Sorry tom um 

2237
01:34:40,096 --> 01:34:42,690
definitely consider making island 

2238
01:34:42,690 --> 01:34:45,750
accessible to the survivors . Um I had 

2239
01:34:45,750 --> 01:34:48,650
one survivor called me and asking 

2240
01:34:48,650 --> 01:34:51,460
assistance in communicating with V . A . 

2241
01:34:51,840 --> 01:34:54,370
To access Tyler as she was filing for 

2242
01:34:54,370 --> 01:34:57,700
presumption for death benefits . Um and 

2243
01:34:57,700 --> 01:35:00,260
and it was difficult because Eyler 

2244
01:35:00,270 --> 01:35:02,550
didn't date back to the time that he 

2245
01:35:02,550 --> 01:35:05,770
was in service . So lots of lots of 

2246
01:35:05,770 --> 01:35:06,826
challenges there . 

2247
01:35:10,140 --> 01:35:13,850
Thank you . Um And dr Cisma you called 

2248
01:35:13,850 --> 01:35:15,961
on D . O . D . To revamp their method 

2249
01:35:15,961 --> 01:35:17,794
of documentation so that medical 

2250
01:35:17,794 --> 01:35:19,572
professionals could have better 

2251
01:35:19,572 --> 01:35:21,350
understanding of their patients 

2252
01:35:21,350 --> 01:35:23,517
potential exposures . What information 

2253
01:35:23,517 --> 01:35:25,960
would be most helpful to you to have as 

2254
01:35:25,970 --> 01:35:28,026
you screen and treat patients . What 

2255
01:35:28,026 --> 01:35:30,248
obstacles do you face with the patients 

2256
01:35:30,248 --> 01:35:32,248
when you're trying to gather needed 

2257
01:35:32,248 --> 01:35:34,248
information about exposure and then 

2258
01:35:34,248 --> 01:35:36,192
further what training do you think 

2259
01:35:36,192 --> 01:35:37,859
should be provided to medical 

2260
01:35:37,859 --> 01:35:40,081
professionals so they can better screen 

2261
01:35:40,081 --> 01:35:42,026
and treat their patients for toxic 

2262
01:35:42,026 --> 01:35:44,248
exposure ? Yeah , we would like to know 

2263
01:35:44,248 --> 01:35:46,026
which region of the country and 

2264
01:35:46,026 --> 01:35:48,248
individual soldier was in what types of 

2265
01:35:48,248 --> 01:35:50,359
munitions they were exposed to , What 

2266
01:35:50,359 --> 01:35:50,100
the chemical makeup of the munitions 

2267
01:35:50,100 --> 01:35:52,520
were , how trash was disposed of in 

2268
01:35:52,520 --> 01:35:54,520
that region , including burn pits , 

2269
01:35:54,520 --> 01:35:56,742
what was in the trash itself , what the 

2270
01:35:56,742 --> 01:35:58,853
weather patterns were because of dust 

2271
01:35:58,853 --> 01:36:01,076
storms in the region . Whether depleted 

2272
01:36:01,076 --> 01:36:03,187
uranium was used in that region . For 

2273
01:36:03,187 --> 01:36:05,131
example , there are armor piercing 

2274
01:36:05,131 --> 01:36:07,131
rounds , PU 14 and tank shells with 

2275
01:36:07,131 --> 01:36:09,242
depleted uranium as well as even ship 

2276
01:36:09,242 --> 01:36:11,353
ballast and whether that soldier used 

2277
01:36:11,353 --> 01:36:13,353
personal protective equipment . All 

2278
01:36:13,353 --> 01:36:15,576
these things are important um regarding 

2279
01:36:15,576 --> 01:36:17,687
training in the V . A . System , most 

2280
01:36:17,687 --> 01:36:19,798
compensation and pension doctors that 

2281
01:36:19,798 --> 01:36:22,020
we've dealt with in the via our primary 

2282
01:36:22,020 --> 01:36:21,770
care doctors , they're not 

2283
01:36:21,770 --> 01:36:25,260
pulmonologist and they're unaware 

2284
01:36:25,270 --> 01:36:27,600
of burn pit and choose which is which 

2285
01:36:27,600 --> 01:36:29,760
actually is flabbergasting at this 

2286
01:36:29,760 --> 01:36:32,570
point in time . But as I mentioned last 

2287
01:36:32,570 --> 01:36:34,514
month we had a case where somebody 

2288
01:36:34,514 --> 01:36:36,737
could not go to the war related illness 

2289
01:36:36,737 --> 01:36:38,848
and injury center , which has been an 

2290
01:36:38,848 --> 01:36:40,848
arbiter and an advocate for us . So 

2291
01:36:40,848 --> 01:36:43,070
they would go to the East Orange via to 

2292
01:36:43,070 --> 01:36:45,292
confirm what we suspected or you know , 

2293
01:36:45,292 --> 01:36:47,530
wanted a second confirmation of and one 

2294
01:36:47,530 --> 01:36:49,960
stumbling block is the the local VMS 

2295
01:36:49,960 --> 01:36:52,090
are using it as a hurdle to not get 

2296
01:36:52,090 --> 01:36:55,520
them benefits . Um Do you think the V . 

2297
01:36:55,520 --> 01:36:57,631
A . S . Need to have pulmonologist on 

2298
01:36:57,631 --> 01:37:00,930
staff ? Okay , well thank you for all 

2299
01:37:00,930 --> 01:37:03,340
your recommendations . Um I think this 

2300
01:37:03,350 --> 01:37:06,190
um panel has been extremely effective 

2301
01:37:06,200 --> 01:37:09,440
in laying out a set of requirements and 

2302
01:37:09,440 --> 01:37:12,560
proposals for how to better address The 

2303
01:37:12,570 --> 01:37:14,737
disease is caused by burn pits and how 

2304
01:37:14,737 --> 01:37:16,990
to document them through active duty . 

2305
01:37:17,000 --> 01:37:19,111
So that when these individuals become 

2306
01:37:19,111 --> 01:37:21,167
better in status , they have all the 

2307
01:37:21,167 --> 01:37:23,278
information they need to protect them 

2308
01:37:23,278 --> 01:37:23,230
because a lot of these diseases take 

2309
01:37:23,230 --> 01:37:25,397
five years or take seven years or take 

2310
01:37:25,397 --> 01:37:27,619
10 years depending on the length of the 

2311
01:37:27,619 --> 01:37:29,619
service of the individual and so we 

2312
01:37:29,619 --> 01:37:31,786
need to have that information in place 

2313
01:37:31,786 --> 01:37:33,841
at the ready so that when they do go 

2314
01:37:33,841 --> 01:37:36,008
from active duty to veterans status as 

2315
01:37:36,008 --> 01:37:38,119
part of the record , um , we're gonna 

2316
01:37:38,119 --> 01:37:40,286
leave this record open for a week . So 

2317
01:37:40,286 --> 01:37:42,508
if there's any testimony that you think 

2318
01:37:42,508 --> 01:37:44,730
of that you would like to give in terms 

2319
01:37:44,730 --> 01:37:46,730
of recommendations in terms of data 

2320
01:37:46,730 --> 01:37:48,786
information , anything else that you 

2321
01:37:48,786 --> 01:37:51,008
want us to have please submit it ? Um , 

2322
01:37:51,008 --> 01:37:53,230
we're really grateful for your advocacy 

2323
01:37:53,230 --> 01:37:55,341
and your testimony today . I think it 

2324
01:37:55,341 --> 01:37:57,452
was thorough and extremely helpful in 

2325
01:37:57,452 --> 01:37:59,674
writing our baseline personnel markup . 

2326
01:37:59,674 --> 01:38:00,786
Thank you very much 

2327
01:38:04,430 --> 01:38:05,400
hearing adjourned .