1 00:00:00,240 --> 00:00:02,570 testimony on the health effects of 2 00:00:02,570 --> 00:00:04,670 exposure to airborne hazards , 3 00:00:04,830 --> 00:00:07,190 including toxic fumes from burn pits . 4 00:00:07,440 --> 00:00:09,329 Let me start by welcoming ranking 5 00:00:09,329 --> 00:00:11,329 member Tillis who will be here very 6 00:00:11,329 --> 00:00:13,329 shortly . Who has been an excellent 7 00:00:13,329 --> 00:00:15,440 partner on this subcommittee over the 8 00:00:15,440 --> 00:00:17,662 last several years , Senator Tillis and 9 00:00:17,662 --> 00:00:17,030 I have shared a commitment to 10 00:00:17,030 --> 00:00:18,974 supporting our service members and 11 00:00:18,974 --> 00:00:20,919 providing them with the services , 12 00:00:20,919 --> 00:00:22,919 resources and care that they need . 13 00:00:22,919 --> 00:00:25,030 That commitment extends to our shared 14 00:00:25,030 --> 00:00:27,141 drive to address the debilitating and 15 00:00:27,141 --> 00:00:28,752 extensive medical issues and 16 00:00:28,752 --> 00:00:30,919 disabilities caused by the use of burn 17 00:00:30,919 --> 00:00:33,640 pits in recent combat operations . When 18 00:00:33,640 --> 00:00:35,640 our service members deployed , they 19 00:00:35,640 --> 00:00:37,807 expect to face risks . But those risks 20 00:00:37,807 --> 00:00:39,973 should not come from the operations of 21 00:00:39,973 --> 00:00:42,060 our own bases and when they do , we 22 00:00:42,060 --> 00:00:45,120 must take responsibility . I look 23 00:00:45,120 --> 00:00:47,287 forward to continuing to work together 24 00:00:47,287 --> 00:00:49,509 on this issue . I was also glad to hear 25 00:00:49,509 --> 00:00:51,342 that President biden prioritized 26 00:00:51,342 --> 00:00:53,300 addressing this cost of war in the 27 00:00:53,300 --> 00:00:55,940 state of the Union and again in texas 28 00:00:55,940 --> 00:00:58,300 last week , he described the clear 29 00:00:58,300 --> 00:01:00,189 cause and effect of this crisis , 30 00:01:00,189 --> 00:01:02,210 saying quote , the burn pits that 31 00:01:02,210 --> 00:01:04,790 incinerate the waste of war , medical 32 00:01:04,790 --> 00:01:07,290 and hazardous material , jet fuel and 33 00:01:07,290 --> 00:01:10,800 so much more were just dug in big pits , 34 00:01:10,920 --> 00:01:13,020 not far from where our veterans were 35 00:01:13,020 --> 00:01:15,800 sleeping and when our troops came home , 36 00:01:15,810 --> 00:01:17,921 the fittest among them , the greatest 37 00:01:17,921 --> 00:01:19,977 fighting force in the history of the 38 00:01:19,977 --> 00:01:22,088 world . Too many of them were not the 39 00:01:22,088 --> 00:01:24,310 same headaches , numbness , dizziness , 40 00:01:24,310 --> 00:01:27,460 cancer that tells the whole story . Men 41 00:01:27,460 --> 00:01:29,571 and women who deployed at the peak of 42 00:01:29,571 --> 00:01:31,627 physical fitness are now fighting to 43 00:01:31,627 --> 00:01:34,430 survive . This is the this is a health 44 00:01:34,430 --> 00:01:37,120 crisis among our armed services . Most 45 00:01:37,120 --> 00:01:39,342 public attention on this issue has been 46 00:01:39,342 --> 00:01:41,564 focused on the treatment of veterans at 47 00:01:41,564 --> 00:01:43,787 the Veterans Administration , but these 48 00:01:43,787 --> 00:01:45,953 health issues stem from time on active 49 00:01:45,953 --> 00:01:48,176 duty and can begin presenting while our 50 00:01:48,176 --> 00:01:50,342 troops are still serving . The D . O . 51 00:01:50,342 --> 00:01:52,520 D . Has a critical role to play in 52 00:01:52,520 --> 00:01:54,576 protecting the health of our current 53 00:01:54,576 --> 00:01:56,576 and transitioning service members . 54 00:01:56,576 --> 00:01:58,409 That's why today's hearing is so 55 00:01:58,409 --> 00:02:00,409 critical . We need to have a better 56 00:02:00,409 --> 00:02:02,631 understanding of how toxic exposure has 57 00:02:02,631 --> 00:02:04,840 been and is being tracked and 58 00:02:04,840 --> 00:02:07,310 documented and the barriers that have 59 00:02:07,310 --> 00:02:09,532 prevented that documentation from being 60 00:02:09,532 --> 00:02:12,220 done effectively . Congress has already 61 00:02:12,220 --> 00:02:14,960 recognized DS DS responsibility and has 62 00:02:14,960 --> 00:02:17,640 passed legislation to require D . O . D . 63 00:02:17,640 --> 00:02:19,807 To take appropriate measures including 64 00:02:19,807 --> 00:02:22,210 requiring inclusion of exposure to open 65 00:02:22,210 --> 00:02:24,520 burn pits in post deployment . Health 66 00:02:24,520 --> 00:02:26,742 assessment of service members returning 67 00:02:26,742 --> 00:02:28,909 from deployment , recording , burn pit 68 00:02:28,909 --> 00:02:30,853 registration and electronic health 69 00:02:30,853 --> 00:02:33,040 records and mandatory training for 70 00:02:33,040 --> 00:02:35,096 military healthcare providers on the 71 00:02:35,096 --> 00:02:38,300 effects of burn pit exposure . But we 72 00:02:38,300 --> 00:02:40,570 need to go further . We need to build 73 00:02:40,570 --> 00:02:42,737 an understanding of the health impacts 74 00:02:42,737 --> 00:02:44,903 of toxic exposure and our knowledge of 75 00:02:44,903 --> 00:02:47,070 when such exposures occurring . And we 76 00:02:47,070 --> 00:02:49,292 must make that information available to 77 00:02:49,292 --> 00:02:51,348 service members , their families and 78 00:02:51,348 --> 00:02:53,514 the medical profession's professionals 79 00:02:53,514 --> 00:02:55,626 they rely on in order to properly and 80 00:02:55,626 --> 00:02:57,848 adequately care for our troops who have 81 00:02:57,848 --> 00:03:00,410 been exposed . As President biden said , 82 00:03:00,420 --> 00:03:03,690 quote , we need to know more about 83 00:03:03,690 --> 00:03:05,690 which of our veterans may have been 84 00:03:05,690 --> 00:03:07,912 exposed to burn pits in the first place 85 00:03:07,912 --> 00:03:09,968 or other environmental toxins during 86 00:03:09,968 --> 00:03:12,150 their service and record possible 87 00:03:12,150 --> 00:03:13,928 exposure before service members 88 00:03:13,928 --> 00:03:16,580 separate from the military and quote , 89 00:03:16,590 --> 00:03:18,860 today's witnesses will help provide 90 00:03:18,860 --> 00:03:20,970 clarity in both of those areas are . 91 00:03:20,970 --> 00:03:22,970 First panel consists of D . O . D . 92 00:03:22,970 --> 00:03:25,137 Witnesses who have testified about the 93 00:03:25,137 --> 00:03:27,081 health effects of toxic exposure , 94 00:03:27,081 --> 00:03:28,803 assessment of health impacts , 95 00:03:28,803 --> 00:03:31,026 documentation of potential exposure and 96 00:03:31,026 --> 00:03:33,248 monitoring of exposure witnesses on our 97 00:03:33,248 --> 00:03:35,414 second panel will share what they have 98 00:03:35,414 --> 00:03:37,526 seen or experienced firsthand on this 99 00:03:37,526 --> 00:03:39,692 issue and will provide recommendations 100 00:03:39,692 --> 00:03:41,803 for ensuring the health and safety of 101 00:03:41,803 --> 00:03:44,026 our service members . Witnesses for our 102 00:03:44,026 --> 00:03:46,303 first panel include Dr Terry M . Roush , 103 00:03:46,540 --> 00:03:48,630 acting deputy assistant secretary of 104 00:03:48,630 --> 00:03:50,852 Defense for health readiness policy and 105 00:03:50,852 --> 00:03:54,050 oversight . Dr Raul Mirza , division 106 00:03:54,050 --> 00:03:56,050 Chief of occupational environmental 107 00:03:56,050 --> 00:03:58,161 Medicine , Clinical Public Health and 108 00:03:58,161 --> 00:04:00,217 epidemiology , US Army Public Health 109 00:04:00,217 --> 00:04:03,000 Center . Colonel Adam Newell . Adam Jay 110 00:04:03,000 --> 00:04:06,110 Newell , Chief of Medical readiness Air 111 00:04:06,110 --> 00:04:08,110 Force Medical readiness Agency and 112 00:04:08,110 --> 00:04:10,332 Captain BRian L . Feldman , Commander , 113 00:04:10,332 --> 00:04:12,790 Navy and Marine Corps Public Health 114 00:04:12,790 --> 00:04:14,734 Center . I'll introduce the second 115 00:04:14,734 --> 00:04:16,957 panel . I have to receive the testimony 116 00:04:16,957 --> 00:04:19,012 of the first panel again . Thank you 117 00:04:19,012 --> 00:04:21,068 for being here today and um just for 118 00:04:21,068 --> 00:04:23,234 senator , tell us his benefit , I told 119 00:04:23,234 --> 00:04:22,780 them how wonderful you are at the 120 00:04:22,780 --> 00:04:25,570 opening of my remarks . Could you 121 00:04:25,570 --> 00:04:28,150 please repeat that ? Uh And I'm sorry 122 00:04:28,150 --> 00:04:30,150 I'm running late . I went ahead and 123 00:04:30,150 --> 00:04:32,206 voted so I figured we could tag team 124 00:04:32,206 --> 00:04:34,317 and not disrupt the hearing but thank 125 00:04:34,317 --> 00:04:36,150 you all for being here . Senator 126 00:04:36,150 --> 00:04:38,317 Gillibrand , thank you for holding the 127 00:04:38,317 --> 00:04:38,150 hearing and your advocacy of the work 128 00:04:38,150 --> 00:04:40,150 that I'm well aware of and veterans 129 00:04:40,150 --> 00:04:42,300 affairs that we need to continue to 130 00:04:42,310 --> 00:04:44,421 work on . I've worked on this subject 131 00:04:44,421 --> 00:04:46,477 for a long time when I first came to 132 00:04:46,477 --> 00:04:48,820 the Senate , I was involved with trying 133 00:04:48,820 --> 00:04:50,876 to get the Presumptions in place for 134 00:04:50,876 --> 00:04:53,209 camp Lejeune toxic exposures down there , 135 00:04:53,209 --> 00:04:56,900 fortunately after um , a lot of back 136 00:04:56,900 --> 00:04:58,950 and forth with the V . A . We were 137 00:04:58,950 --> 00:05:01,061 successful , but we have more work to 138 00:05:01,061 --> 00:05:03,280 do . And I'm happy that the Veterans 139 00:05:03,280 --> 00:05:06,400 Affairs Committee has unanimously 140 00:05:06,400 --> 00:05:08,733 reported out a bill on toxic substances . 141 00:05:08,733 --> 00:05:10,900 We're going to continue to work in the 142 00:05:10,900 --> 00:05:13,067 V . A . Committee to do right by those 143 00:05:13,067 --> 00:05:15,067 who were exposed and who are now in 144 00:05:15,067 --> 00:05:17,178 veteran status . The the objective of 145 00:05:17,178 --> 00:05:19,067 today's hearing though . And it's 146 00:05:19,067 --> 00:05:21,289 something that I've said um on a number 147 00:05:21,289 --> 00:05:23,233 of fronts , whether it's traumatic 148 00:05:23,233 --> 00:05:25,289 brain injury , low level , low level 149 00:05:25,289 --> 00:05:27,511 concussive events , things that men and 150 00:05:27,511 --> 00:05:29,511 women while they're inactive status 151 00:05:29,511 --> 00:05:31,733 experience that could ultimately result 152 00:05:31,733 --> 00:05:33,900 in problems in the long term . I think 153 00:05:33,900 --> 00:05:36,011 we have an opportunity to hear to get 154 00:05:36,011 --> 00:05:38,178 ahead of it instead of waiting for the 155 00:05:38,178 --> 00:05:40,500 next burn pit are waiting for the next 156 00:05:40,510 --> 00:05:42,660 agent Orange , What more can we do 157 00:05:43,140 --> 00:05:45,251 downrange ? What war can we do in our 158 00:05:45,251 --> 00:05:47,850 military installations to understand 159 00:05:48,240 --> 00:05:51,580 the potential risk that we're 160 00:05:51,580 --> 00:05:54,960 putting our men and women um , 161 00:05:55,340 --> 00:05:57,530 potentially putting them in a position 162 00:05:57,540 --> 00:05:59,960 to where they too are going to have 163 00:05:59,970 --> 00:06:02,200 negative health consequences either 164 00:06:02,200 --> 00:06:04,200 while they're serving or after they 165 00:06:04,200 --> 00:06:06,367 transition a veteran status . So today 166 00:06:06,367 --> 00:06:08,533 I look forward to talking with you all 167 00:06:08,533 --> 00:06:10,700 about how we can get ahead of the curb 168 00:06:10,700 --> 00:06:12,867 how we can do a better job of tracking 169 00:06:12,867 --> 00:06:15,033 potential exposure so that it makes it 170 00:06:15,033 --> 00:06:17,144 very easy later on . If we get into a 171 00:06:17,144 --> 00:06:19,311 situation we can't always , when we're 172 00:06:19,311 --> 00:06:19,060 downrange know what we're going to get 173 00:06:19,060 --> 00:06:21,640 exposed to . But once we know it , then 174 00:06:21,640 --> 00:06:23,751 we should make sure that every single 175 00:06:23,751 --> 00:06:25,918 electronic health record of any man or 176 00:06:25,918 --> 00:06:28,030 woman who's exposed to it is updated 177 00:06:28,050 --> 00:06:30,440 and maybe we can even anticipate that 178 00:06:30,440 --> 00:06:32,273 they're at risk before they ever 179 00:06:32,273 --> 00:06:34,440 exhibit the first symptom . That's the 180 00:06:34,440 --> 00:06:37,180 end goal . And I'm sure that I I uh 181 00:06:37,190 --> 00:06:39,301 that that you all the witnesses agree 182 00:06:39,301 --> 00:06:41,246 that that should be an end goal of 183 00:06:41,246 --> 00:06:43,246 everybody . Um so I look forward to 184 00:06:43,246 --> 00:06:45,357 this testimony today . I look forward 185 00:06:45,357 --> 00:06:47,523 to moving up in the cycle talking with 186 00:06:47,523 --> 00:06:47,440 the D . O . D . To figure out what more 187 00:06:47,440 --> 00:06:49,850 we can do to actually begin to bend the 188 00:06:49,850 --> 00:06:52,017 curve on some of the consequences that 189 00:06:52,017 --> 00:06:54,128 we have to deal with with our men and 190 00:06:54,128 --> 00:06:56,239 women in uniform and with the men and 191 00:06:56,239 --> 00:06:58,461 women who have served before . So thank 192 00:06:58,461 --> 00:06:58,160 you all look forward to your testimony . 193 00:07:01,440 --> 00:07:04,250 Colonel Newell . Right , 194 00:07:06,840 --> 00:07:10,760 well , dr Roush , I got 195 00:07:10,760 --> 00:07:14,490 it . Chairwoman Jilib 196 00:07:14,490 --> 00:07:17,660 earn ranking member tell us and members 197 00:07:17,660 --> 00:07:20,740 of the subcommittee . Thank you for 198 00:07:20,740 --> 00:07:24,360 inviting the department to testify for 199 00:07:24,740 --> 00:07:27,020 the Senate Armed Services committee 200 00:07:27,070 --> 00:07:29,530 hearing on military exposures of 201 00:07:29,530 --> 00:07:32,190 concern , including airborne hazards 202 00:07:32,190 --> 00:07:35,110 and open burn pits . I'm pleased to 203 00:07:35,110 --> 00:07:37,780 represent the office of the Secretary 204 00:07:37,780 --> 00:07:40,220 of defense and have the opportunity to 205 00:07:40,220 --> 00:07:43,140 discuss the department's actions in 206 00:07:43,340 --> 00:07:46,160 addressing airborne contaminants and 207 00:07:46,160 --> 00:07:49,370 open burn pits in military operations 208 00:07:49,460 --> 00:07:52,470 and the potential health effects to our 209 00:07:52,480 --> 00:07:55,620 service members and veterans joining me 210 00:07:55,620 --> 00:07:57,700 today in representing their military 211 00:07:57,700 --> 00:08:00,330 departments are Colonel New new from 212 00:08:00,330 --> 00:08:03,430 the Air Force DR MErcer from the Army 213 00:08:03,430 --> 00:08:06,510 and Captain Feldman from the Navy . The 214 00:08:06,510 --> 00:08:10,310 department recognizes the concerns 215 00:08:10,310 --> 00:08:12,630 about the potential health impact of 216 00:08:12,630 --> 00:08:15,860 burn pits and other airborne exposures . 217 00:08:16,240 --> 00:08:18,690 The relationship between burn pit 218 00:08:18,690 --> 00:08:21,160 exposure and illness is a topic of 219 00:08:21,540 --> 00:08:25,220 active research by the department , the 220 00:08:25,220 --> 00:08:28,760 via national Academies of 221 00:08:29,140 --> 00:08:31,210 Science Engineering and Medicine and 222 00:08:31,210 --> 00:08:33,540 other research institutions . The 223 00:08:33,540 --> 00:08:36,710 department and via continued to support 224 00:08:36,710 --> 00:08:39,290 and fund these research efforts to 225 00:08:39,290 --> 00:08:41,690 better understand any health effects 226 00:08:41,690 --> 00:08:45,090 that will better inform the health care 227 00:08:45,090 --> 00:08:47,270 provided to our service members and 228 00:08:47,270 --> 00:08:50,590 veterans healthcare providers play a 229 00:08:50,600 --> 00:08:53,060 critical role in understanding 230 00:08:54,440 --> 00:08:56,960 health related exposures in becoming 231 00:08:57,540 --> 00:09:00,410 proficient in assessing patients 232 00:09:00,580 --> 00:09:03,990 exposure concerns . This month the 233 00:09:03,990 --> 00:09:06,860 department will launch an updated 234 00:09:06,860 --> 00:09:09,580 version of its airborne hazards and 235 00:09:09,590 --> 00:09:13,260 open burn pit registry overview 236 00:09:13,260 --> 00:09:17,140 course for healthcare providers . In 237 00:09:17,140 --> 00:09:20,820 addition to the training course , an 238 00:09:20,820 --> 00:09:24,380 airborne exposure clinical toolbox is 239 00:09:24,380 --> 00:09:26,860 available to our healthcare providers . 240 00:09:27,340 --> 00:09:29,062 The department and the B . A . 241 00:09:29,062 --> 00:09:31,700 Continued to share education training 242 00:09:31,700 --> 00:09:34,670 and outreach products to improve 243 00:09:34,970 --> 00:09:37,260 exposure related clinical care . 244 00:09:37,740 --> 00:09:41,310 Airborne hazards pose potential acute 245 00:09:41,320 --> 00:09:43,209 and chronic health effects during 246 00:09:43,209 --> 00:09:46,760 deployment and post deployment as such . 247 00:09:47,140 --> 00:09:50,950 The department has enhanced its pre and 248 00:09:50,950 --> 00:09:53,790 post deployment related health 249 00:09:53,790 --> 00:09:56,910 assessments and the 250 00:09:56,910 --> 00:09:59,150 separation health assessment 251 00:09:59,990 --> 00:10:03,380 to include more specific 252 00:10:03,390 --> 00:10:06,100 occupational and environmental exposure 253 00:10:06,100 --> 00:10:09,560 questions including questions on burn 254 00:10:09,560 --> 00:10:13,210 pits and other airborne hazards . The 255 00:10:13,210 --> 00:10:15,280 department and via are currently 256 00:10:15,280 --> 00:10:17,970 collaborating on multiple efforts 257 00:10:17,970 --> 00:10:20,740 including the development of the first 258 00:10:20,740 --> 00:10:24,420 ever individual longitudinal exposure 259 00:10:24,420 --> 00:10:26,560 record . We call it the island , 260 00:10:27,340 --> 00:10:30,110 providing exposure summaries by 261 00:10:30,110 --> 00:10:32,750 leveraging personnel location , 262 00:10:33,440 --> 00:10:35,670 environmental monitoring and health 263 00:10:35,810 --> 00:10:38,810 assessment data . The department is 264 00:10:38,810 --> 00:10:40,920 also conducting a comprehensive 265 00:10:40,920 --> 00:10:44,110 exposure monitoring capabilities based 266 00:10:44,110 --> 00:10:46,500 assessment aimed at improving 267 00:10:46,510 --> 00:10:50,400 individual and area exposure monitoring 268 00:10:50,530 --> 00:10:52,430 and record keeping across the 269 00:10:52,430 --> 00:10:55,550 installation , training and deployed 270 00:10:55,880 --> 00:10:58,430 environments . In closing the 271 00:10:58,430 --> 00:11:01,800 department remains committed to 272 00:11:01,800 --> 00:11:05,030 continually improving our understanding 273 00:11:05,030 --> 00:11:08,110 of exposures of concern and potential 274 00:11:08,110 --> 00:11:10,850 health effects in order to prevent and 275 00:11:10,850 --> 00:11:13,470 mitigate exposures and clinically 276 00:11:13,470 --> 00:11:16,760 assess treat and care for our service 277 00:11:16,760 --> 00:11:18,950 members and veterans 278 00:11:23,740 --> 00:11:26,970 Madam . Chair Woman that concludes my 279 00:11:26,970 --> 00:11:29,470 opening remark and we stand ready to 280 00:11:29,480 --> 00:11:31,630 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 .