Transcripts For CSPAN Hearing On Veterans Health After Exposure To Hazardous Chemicals 20240711

Welcome to todays hybrid hearing to have subcommittee on the committee of oversight and government reform. Some members will appear in erson and others will appear remotely via webex. Pursuant toe latest guidance from the house attending physician, all individuals attending this hearing in person must wear a face mask. Members who are not wearing a face mask will not be recognized. Let me also make a few reminders for those members that are appearing in person. You will only see members and witnesses appearing remotely on the monitor in front of you when they are speaking in what is known as active speaker mode. A timer is visible directly in front of you. For the members appearing remotely i know that you are all aware by now. But let me remind everyone of a few points first. You will be able to see each other speaking during the hearing. Whether they are in person or remote as long as you have your web said to active speaker mode. If you have any questions about this activation, please contact the Committee Staff immediately. Second, we have a timer that should be visible on your screen when you are in active speaker mode with a thumbnail view. Third, the house rules require that we can see you. So, please have your camera turned on at all times. Fourth, members appearing remotely who are not recognized should remain on mute to minimize background noise and feedback. Last, i will recognize members verbally. But members maintain the right to seek recognition verbally and in regular order members will be recognized in seniority order for questions. If you want to be recognized outside of regular order, you may identify that in several ways. You may use the chat function to send a request. You may send an email to the majority staff or you may unmute your microphone to seek recognition directly. Obviously we do not want people talking over each other so my preference is that we use the chat function or email to the extent possible to facilitate formal and verbal recognition. Committee staff will ensure that i am made aware of the requests and i will recognize it. We will begin in just a moment when they tell me they are ready to begin the live stream. Okay. The committee will come to order and without objection the chair is authorized to declare a recess to the committee at any time. I will now recognize myself for an Opening Statement. Good morning everyone again. Last week we celebrated veterans day to honor the brave men and women who were sworn to protect the United States throughout the nations history. Our country owes them all a solid debt of gratitude. Too often, however, when our sons and daughters in uniform have returned home with the scars of the war, our government has failed them. From agent orange in vietnam to the toxic exposures from the burn pits in iraq and afghanistan. Our nations veterans have repeatedly sought the acknowledgment of their injuries and assistance from washington only to be met with resistance, skepticism and doubt. This story is regrettably playing out once again for the soldiers, airmen, marines and National Guardsmen who deployed to karshikhanabad better known as k2, which is a former soviet airbase in his pakistan on the afghan border. That the u. S. Forces used to support military operations in afghanistan following the september 11th terrorist attacks. Between 2001 and 2005, more than 15,000 men and women deployed to support the Operation Enduring freedom and declassified assessments conducted by the military at the early 20s there is a rose and released by our committee in july show that Service Members who deployed were exposed to multiple harmful toxins and environmental hazards left over from the former soviet occupants including jet fuel, organic compound, depleted uranium, particulate matter and other cancercausing chemicals connected to the Prior Service and exposure at k2 and despite the evidence the members were exposed to the dangerous hazards the va inexplicably continues to deny that the life altering illness as reported by the veterans and serviceconnected its to the Service Members and five times, five times more likely to develop certain forms of cancer compared with others who deployed to south korea and other deployments. The continued denial has left hundreds if not thousands of veterans and eligible for certain Preventative Health problems and unable to receive a disability benefit in connection with the service in k2. This is an injustice that must be rectified and secretary has the authority to fix it by granting presumptive status to the veterans. If they send the sons and daughters who wore then we must be prepared to care for them upon their return home. And for the subcommittee has been inadequate. If not for our oversight of the dod likely would not have declassified hundreds of pages detailing the toxic hazards the u. S. Forces were exposed to. And the va would likely have not committed to launching a new epidemiological study. I knew i was going to stumble on that. Even then the dod withheld the classified documents from the committee for months and the study is expected to take at least a year all while the veterans are left waiting for answers. While a appreciate the participation as well as the service to the country im disappointed the va declined to provide a policymaker as we requested on a bipartisan basis to testify alongside of doctor hasting at todays hearings. The families who sacrificed enough on behalf of the nation and many are still suffering. They deserve the highest level of attention from both departments and sending an additional representative to testify alongside at todays hearing would have fully demonstrated that commitment. Before i yield the floo yieldedo the Ranking Member, i would like to personally thank him and the Ranking Member for the bipartisanship that they and their very capable staff demonstrated throughout this investigation. We worked as partners as we should. I would also like to thank the chairwoman for her unwavering support of our post9 11 warriors as well as the gentleman from tennessee, congressman greene for his partnership and leadership on this issue and for cosponsoring 5957 the toxic exposure accountability act of 2020. We did that earlier this year. With that i will yield to the Ranking Member from the great state of sconce and. Thank you very much. It is a bipartisan priority and im glad we were able to Work Together on this. Helping those serving is very important and i would like to thank doctor green the member of the subcommittee who served. I want to offer my gratitude and continue to fight to bring justice that served along with them. I think the chair man for your work and i want to echo your statements i think that is a minimum that should be expected. With the utmost respect for you, doctor hastings it is important to you with the administrative policy remedies makes for these veterans. I hope that you will still find an appropriate time to hear from the senior va policymaker even at this late date. Without significant support from both your departments, any congressional effort to make the veterans whole after the attacks on september 11th we deployed the units to k2 and his pakistan in preparation for the invasion to afghanistan. And with the soviet base unfortunately with serious toxic risks and we knew of those toxic risks as i understand it before we deployed the troops there. We heard stories of black sludge coming up from the ground and contaminated soil throughout the base. Since it was closed thereve been numerous illnesses and deaths reported from those who served and we will ask some questions regarding that today. It is a largely forgotten tragedy and i understand and am encouraged by the efforts undertaken by both of you to understand more about the dangers associated with the development of the roster would make muchneeded transparency and help Congress Make determinations quite frankly conducting a convergence of study to assess the connections between the toxic exposure and subsequent illnesses encouraging that is a good start and we must continue to push forward. Since the last hearing in february numerous sites and Operational Health Risk Assessments have been declassified and they show multitudes of toxins the Service Members could be exposed to including jet fuel and radiation. Shockingly, these arguments of the previous testimony showed that the military leaders didnt communicate the risk with a station there despite being instructed to do so which is callousness. I fully understand, but i hope that you feel as we do that we owe a little more attention to the people that their lives on the line for the country and we need to be encouraging the screenings for those who served and we need to be encouraging the veterans to speak up and come to the va to seek treatment. The subcommittee will continue to fight for all Service Members that were stationed and we cannot afford to sit idly by as they put their lives on the line for this country and continue to get sick. I hope everyone including the press will do what is best to move forward and thank you to the witnesses for being there. I would thank you one more time for showing this and having this hearing. I yelled back. I think the Ranking Member. Before we continue, i have a few housekeeping matters. Without objection, the gentlewoman from california the general woman they have each done extensive work on this issue and caring for the veterans in general and we appreciate their participation. They are each subcommittee chairs on Armed Services so they do deal directly with the subject matter as well. I would like to introduce the witnesses first today we have doctor james smith the secretary of defense for Health Readiness policy and oversight at the department of defense. Welcome. And we are also going to hear from doctor Patricia Hastings who is the chief consultant for the post Deployment Health service at the department of Veterans Affairs. And in accordance with of the committee rules, would you both please rise and raise your right hand. Do you swear or affirm the testimony you are about to give is the truth, the whole truth and nothing but the truth, so help you god . You may be seated. Let the record show that the witnesses have answered in the affirmative and without objection, your written statements will be made a part of the record and with that, doctor smith, you are recognized to offer a verbal presentation and summary of your testimony. Good morning Ranking Member and the other distinguished members of the committee. It is my pleasure to appear before you today representing the department of defense to address any concerns or questions members may have regarding the environmental positions at the karshikhanabad air base or k2 as we call it and the departments efforts to protect the health of current and former Service Members who deployed to that location. First, i would like to acknowledge in the 15 years since its closure, several k2 veterans have passed away and many have reported Significant Health challenges. The untimely death or development of illness an in the current or former Service Members is a great concern to the department. And i personally want to express my Heartfelt Sympathies and condolences to any Service Members and family members affected they follow the policies regarding the environmental evaluation of the bases. There is been extensive sampling of soil, water and air and we documented the results of these evaluations and implemented appropriate mitigation steps. We conducted followup environmental evaluations in 2002 and 2004 and made the summary of the findings and the conclusions publicly available. In response to the concerns voiced by the Service Members, the department has conducted two studies of individuals who deployed to k2. The results of the studies were reviewed by the joint va Health Working group at the time of completion. The overall conclusion of the studies did not support or worsen the outcomes of k2 when compared to those contemporaneously deployed to korea. But nonetheless there were some specific diseases, specifically lymphatic cancers that appeared among the group at a rate higher than expected. In response to the concerns raised by your committee about the health of the veterans, the department immediately renewed the discussions with the department of Veterans Affairs and worked closely with colleagues and designing and implementing a much larger study of k2. So any association between the deployment and Adverse Health effects can be determined in a manner that scientifically is rigorous and comprehensive in its analysis. As you know, ive submitted written testimony in addition to the oral statement, and at this point i look forward after doctor hastings testimony for Opening Statements to answer your questions. The health and wellbeing of the members is my top priority and remains the top priority for the department. Thank you very much. Doctor hastings, you are now recognized for a verbal presentation. [inaudible] make sure that your microphone is on. Chair man, Ranking Member and members of the subcommittee, thank you for the opportunity to discuss the ongoing activities and research the va has undertaken to address the Health Concerns that may be associated with exposure to environmental hazards among veterans who were deployed between 2001 and 20042 karshikhanabad a former soviet airbase in uzbekistan also known as k2. The va is very aware that we owe those who served at k2 in understanding of possible Health Outcomes. The va is committed to finding the answers and has embarked on a specific study. That study will be longterm and not a onetime effort looking at this cohort. The department of defense did the initial and subsequent site assessments and theyve also share them with the va and working as doctor smith said very early on with the deployment working health group and compared the Service Members to a group deployed to south korea but never deployed to southwest asia. This was seven cases at k2 and five cases in korea. The small number of cases could be a coincidence, but it could also be an early signal. Even a small number of cancers and servicemembers that are relatively young is a cause for concern the va is taking these results very seriously, specifically for cancer and also looking at other Health Outcomes the va will expand upon the 2015 Public Health center study. Weve identified with the help of the 15,777 in the total cohort those are currently veterans with 34 still on active duty theres a prospective epidemiological study to address the possible association between Health Conditions and exposure to the environmental hazards during their deployment. This will take 12 to 18 months to complete with the current assets. The study will also include assessments of morbidity and this will be looking at not only cancers but also circulatory respiratory, neurological and other conditions. It includes a very good set of Comparison Groups and it will be a group of Operation Enduring freedom, cohort that served at the same time and the group that did not deploy to southwest asia and we plan for this to go on for approximately 20 years because of the latency of some of the issues that may come up with the cancer concerns. In conclusion, the va is committed to looking at the health and wellbeing of all veterans but specifically here the k2 veterans and we are dedicated to looking at the longterm Health Consequences. This is expected to translate into better care for the veterans and it is also expected to help the dod looking at future protective measures they want to take during deployments, and we do appreciate your support. We are now available for your questions. Thank you very much. Thank you for your testimony. Just to begin, i am blessed in my district we have three va hospitals within my district in massachusetts and Jamaica Plain and massachusetts as well. We are extremely thankful for the wonderful work that its done by our doctors and staff, therapists and Wonderful Service they render to the area that we service, so we are very thankful for the job that they have done. During the investigation, we heard from dozens whose lives have been irreversibly altered. I would like to take a moment to share just a few. Sergeant wilson joined the air force in 98 and deployed to k2 in december of 2001. He returned in 2013, but just three years later he was diagnosed with primary Central Nervous system lymphoma. A mile and a half and a mechanical wheelchair twice a week to attend physical therapy appointments. [inaudible] and testimony before the subcommittee in february he wrote at one time it was worried since i was younger than my wife i would outlive her. However now every day all i can think about is how will she go on after im gone. We have all of my final arrangements in order and how will my sons be taken care of. Constituents from norwood massachusetts and they have a long strong history of military service and patriotism to the country throughout its history. One lost her husband when he was only 36yearsold. He left behind four young children, one of whom followed in his fathers footsteps and graduated from west point and is serving in active duty. To date, k2 veterans have selfreported nearly 500 instances of cancer and nearly 2,000 Adverse Health conditions. These veterans and their families quite frankly sacrificed enough. Theres more than enough evidence produced by the subcommittee and produced by the army and by the k2 veterans themselves to indicate if the conditions of service connect. But when k2 veterans turn for help, they hear the same thing over and over. Theres no presumption associated and there is no indication that it creates cancer. What is the danger in provid is thing and what we are guarding against, lets think about the upside of this. Presumption would provide any of these veterans coming forward with cancer theyve come in and reported cancer. That is not in dispute. It is a 15,000 personnel universe of people probably much less right now and they come forward with accurately diagnosed types of cancers. What the va is saying is we acknowledge youve got cancer and served at k2 and we acknowledge that the army has reported that there were radioactive isotopes that depleted uranium and there was jet fuel and toxic substances where you served and it permeated the ground. Its been evacuated. We have done the samples and we know of those Hazardous Substances and some cases radioactive. And we have science where the military puts signs up, radioactive area, please keep out and it does nothing. The radiation goes right through and we kept the soldiers there. So, knowing all of that and only theyve demonstrated and have been diagnosed by the va and others that theyve got cancer, and we deny them coverage for benefits because we say we think you may not have gotten it here. So, it is a veteran with cancer, and we are denying them benefits. The downside is that maybe one of them got cancer from a source other than k2 and they might be covered. In my opinion, that is not i would absorb that risk if there are a few poor souls that might get treatment and benefits because theyve got cancer after putting on their uniform and serving their country. If that is the downside for the government here, i embrace it. Cover them all. Give them the benefits and care that they deserve. But do not deny them all for the misplaced concern a couple of veterans with cancer might get treatment and benefits that they might not have connected to the service. I see the duty that we own as being primary. And i see a great disservice being done to the families and veterans for a bureaucratic mess ordering of priorities. Why would we deny this presumption without the evidence in hand when we owe them so much and the consequences of not providing the benefits and care are devastating to these families. And my opinion, disrespectful of the services. Could you help me with that . I am a veteran of 33 years. Thank you for your service. Appreciate that. Thank you for giving me a job that ive loved my entire life. So we are committed to veterans and im here specifically because i want to take care of the trends. And doctor stone as an aside was also at k2, so he understands the imperative. It would be a disservice to the veterans to simply say, and this is all veterans, to simply say we dont know how you got it, were just going to cover. My office looks at the science and i want to find out what the exposures were. I would like to tell you a little bit about the depleted uranium if i could. You, congress, supported the center in baltimore for over 30 years and we have an incredible amount of experience with depleted uranium and every two years to look at them in the friendly fire incidents and they do not have an excess mortality looked at every two years for the people concerned about exposure and only five have been positive and embedded those that havent been identified by them before we had 37 turned in from the cohort and 25 that were completed. All are negative for the signature of depleted uranium. What about jet fuel . To finish for just a moment, we are absolutely willing to do a urine on every single veteran for peace of mind. With regards to the underground tanks, the dod did look at the volatile organic compounds and didnt find them to be at a hazardous level. You can go back to the depleted uranium there was a weapon that was designated and blew up outside. It can only penetrate to about two levels so it would have been protected and absolutely people should not have gone anywhere near the areas. In those areas you wouldnt be measured at high levels away from those hotspots. And they were mitigated. The other spots it was a very dusty environment. My office is continuing to look at the issues. We are worried about lead. There was one building that had lead paint so we are looking at all these things but if i simply say right now you have cancer, we are covering it. I want to find a reason so that this doesnt happen again. Many of these veterans some of them have already passed away. The longer the va and the dod extend the time off from the spill, its sort of meaningless to a lot of these families. I agree time is of the essence and that is why my office, good science takes time and we have what has been described as an elegant epidemiologists like to use that term in the protocol and it will give us many of the answers that you seek. It will take some time and we are working with the dod to make sure we have the entire cohort and all of the data and to have the Comparison Groups. But you are right this is the imperative. I would like to reclaim my time and then we can move on. The recommended mitigation measure was dont dig, dont disturb the soil. That was the mitigation that was recommended on site. The other thing is i understand you said its going to take time, but its been 20 years since some of these veterans served at k2 and acquired these diseases, so that is not comforting for a lot of these families. Twenty years as a long time, and we know that. But you understand that we cannot allow this situation to continue and thats why we asked to have someone from the va, a senior policymaker to testify today in your place. In fact i would now like to add to the record november 10th, a letter from myself, the chairwoman, Ranking Member and the gentleman from wisconsin to the secretary making that request so we might have someone that could actually change the policy or demand that the policy be changed on behalf of these veterans and their families. It shouldnt be this hard for the men and women who raise the right hand in service to the nation to get the healthcare and disability benefits that they have earned by their courageous service. The va needs to fix this. It needs to fix this now. I would now yield to my friend, the Ranking Member, the gentleman from wisconsin, for five minutes for his questions. There were, and this is a study that epidemiologists would call hypothesis generating study. They looked at many different outcomes and they found that in hemopoietic cancers that there is an increase in incidents of the michelin initially they found no melanoma but when they did the normalization and the various work done by epidemiologists that was no longer considered statistically significant. Will wear the numbers on that . I think it was eight. Eight. What was the difference between the groups . Yes sir the relative risk as i said at the beginning was 5. 64. The confidence interval is very wide. Ranged from. What is 5. 64 main . That there is five times increased risk initially but the study as you may have seen has caveat about extensively because of the size and the numbers. We dont now and thats the reason why its very important to do the studies we are doing now. Can you nail down the numbers for his . Like how many people have the cancer and k2 and how many were added in the control group . Yes sir. It was eight in both. Eight people had it in the k2 group and how many habits and the other group . I believe was also a. Was the group a lot smaller. It was larger. Okay kind of significant amounts there. The Stronghold Freedom Foundation which you are familiar with, right . Yes sir. Same if they claim and 45 veterans they found 500 instances of adverse effects of toxin exposure. Familiar with their study . Ive not seen their study but ive heard the testimony etc. Have you looked into where they got those numbers . That is the purpose of the study. We have characterized those that are on k2 in the medical work to track this down. Okay, thats a lot of people. Thats over 10 in. If the numbers are accurate. We have so far found 15,777 that were deployed to k2 yes sir. Okay and if i could correct myself i just looked it up. There were seven emphatic neoplasms in the k2 group and there were six in the Comparison Group. Said the Comparison Group had a lot more people. Yes sir. It really comes across. Whatever part 1000 people comes across as five times as many than a to group. Said thats the relative guests sir. Isnt that huge . I know their small numbers but is it significant . Whenever we do these studies it does raise the question. Are there other types of cancers that went the other way . Yes sir. Give me an example. I dont have a study in front of me but in general overall there were not other statistically significant once but there was a greater number of cancers in general when he looked across all of them in this cohort. They were healthier and the other measures. Youre telling me the k2 group was healthier than the other group . As far as there are parameters that we looked out. Okay. Now you are aware or the military was apparently aware before you you were deployed there, i give you a followup because youre making the point that you want to make. You have specific examples you can elaborate on showing thats where the korean group was not . C i can take that one in the study. One more followup question. You apparently knew about the potential hazards before the chips were deployed there and i suppose things to be taken as where the troops move on the base and that sort of thing. It appears as though that something should have been sent to the troops about potential hazards and they werent told about it. That accurate . No sir. I cant speak to the actual individual but clearly in the various reports that we have provided to you there were documented evidence of town halls, various information brochures that were prepared. It was made quite clear as part of our policy to make sure you communicate the results. Each time there were multiple different assessments done at k2 and each time there was an in brief and out brief questions all the people that were adjusted and some of them as you will see as you read through the reports actually were mandatory for all people that were at k2. There were also information for both the players and for the providers. We also as you know did help assessments to be able to make sure if there any concerns that they are recognized and that we have those discussions with them entity of valuations that are required so i do not think its accurate to say there wasnt any communication with individuals deployed. Okay, thank you. The gentleman yields back. The chair now recognizes the full Committee Chairperson the gentlelady from new york ms. Maloney for five minutes. Thank you for holding this important hearing. I have supported this investigation since day one because it has so many parallels to the experience of the 9 11 First Responders where we have to work for years to get them the help that they needed. In both cases great men and women answered the call to serve this country but when they asked for help they were too often ignored and not met with any kind of help but only delay after delay. Thats why the initial responses from both the department of defense and the part of veteran affairs to the concerns of k2 veterans and our committee have been so disappointing. The mcclatchy news outlets recorded reported the k2 veterans were being diagnosed with cancer at alarming rates and the First Response was telling Mcclatchy Cote the premise of your inquiry is false. At the time we knew that at least 61 k2 veterans had been diagnosed with cancer. In response to the first letter the chairman lynch and i said into the va in january, the secretary wilke responded by saying quote there is no presumption associate with k2 and currently theres no indication of increased cancers end quote. It wasnt until april after continued pressure from this committee that the va stated it will conduct a new health study of k2 veterans get the va told us once again quote currently there is no indication of increased cancers end quote. They said even while acknowledging reports that there were 660 instances of cancer among k2 veterans veterans have selfreported almost 500 instances of cancer within their communities. My question is dr. Hastings why did it take the involvement of our committee for the va to begin studying k2 . Maam im very glad to have the support of this committee. Its exceedingly important that i would not characterize va is not caring. There was not an indication of an increased cancer rate when dr. Wilkie wrote that letter. My office is exploring this in its totality. I would like to note that 59 of the k2 veterans have submitted a claim for their service and in most cases the claims are related to those normal things that we see with people who have worked hard in the military and that is musculoskeletal issues. 20 people have turned in a claim that is related specifically to k2. Im right now looking at the statistics with the va to find other answers and what are the things that are being put in its claims. Im very concerned about any environmental exposure for any veteran and my office explores this study thats been done. My time is limited and i apologize my time is limited. I would say 52 reported, 500 selfreported by veterans and no action until this committee got involved demanding answers. You may have been very concerned that my question was why were you slow in responding and why did you not act on it before we made a request with questions in writing to you congratulate chairman for his constant attention on it but also i want to ask dod was slow to respond to the concerns. Chairman lynch and i first the department to provide all environmental and Health Assessments related to k2 on january 13, 2020. By the time we receive declassified versions of these documents in june it showed they had been declassified months before between favorite 14th of february 24. These documents were declassified before the midi held a hearing with k2 veterans on february 27 get dod provided classified versions of the documents to the subcommittee on march 18. Dr. Smith of these assessments were declassified in february and you care so much about helping veterans why didnt the department make them public or at least produce them to the committee right away . Maam i cant answer for the timeline of getting the products over to you but i do know that we have provided the information that we have. I apologize for any delays on behalf of the department. Im glad that you have what you have. Right now whats classified assessments were given to the committee if they were declassified in february . I would say the actions resulted in months of wasted time time that these veterans cannot get back to the fact that it took russia from congress and i are reports from the press to get the va and dod to even acknowledge is unfortunate and does a disservice to our veterans. Thank the chairman for his leadership and i yield back. Thank you. The gentlelady yields back or the chair now recognizes to come in from texas mr. Cloud for five minutes. You are now recognized. Can you pass on me for the moment and come back to me . Im sorry, repeat. You want to pass . The chairman recognize the gentleman from louisiana mr. Higgins for five minutes. Thank you chairman. I appreciate this hearing. I won hundred agree with your line of questioning mr. Chairman. This is a frustrating category of topics between veterans and the va. Thank you for your own service maam. We have veteran brothers and sisters across the country that are watching this very carefully. Its a familiar story. Agent orange, k2 and now we are discussing today there are three elements for granting presumptive condition of the current diagnosis of the disease and an inservice event and a link between the inservice event and that diagnosis. What would have happened and what would be the push back if the va granted presumptive conditions for k2 veterans that present with conditions that may be associated with their inservice retirement with k2. What would be the push back . Would you please answer that briefly . Now one would get in trouble as such. When we put a presumption together. Thank you. In the interest of time with all due respect we are trying to establish veterans rights to services here. Let we just he just acknowledged nobody is in trouble. If the va ran out of trouble you come back to congress. It happens all the time. What i would like to note is that its a was in your power to grant the presumptive condition to k2 veterans would he do it . Not at this time, no. Why not . I want to have an absolute answer for the veterans what i want them to know. By all means studied deeper scientific understanding. You are committed to find answers and looking at longterm studies, large group studies. The current findings could be an early signal. You have veterans that dont have time. They dont have time for longterm study. I dont understand why the va would not just grant presumptive conditions with the k2 veterans who present with conditions and diseases that very well may have been by their service exposure to conditions at k2. None of us on this committee are saying a. By all means conduct your longterm studies but in the meantime grant these veterans their presumptive coverage that they need to address diseases that they very likely contracted while in service to our country with k2. Please explain to the committee what you said that theres no push back. Nobody would get in trouble but these veterans and their families almost certainly are in trouble with their Health Conditions. I will give you my remaining time. Please respond because we dont understand on this committee why the va would not go ahead well youre doing your longterm study. Knock yourselves out with a longterm study. We needed but in the meantime grant veterans the presumptive coverage that they need. You said it was in your power you would not do it. A give you 45 seconds to explain and again thank you for your service. We get it that you are dedicated. We do not understand this provided service to our veterans. See that most veterans receive direct Service Connection and as i said 59 of the k2 veterans have turned in a claim. 20 of them are specifically the leave related to k2 in the put it in that way. Veterans are able and fleeing courage everybody to turn in a claim if they believe military services negatively impacting them but at this point in time the secretary in order to put forward a presumption would need to have scientific support hand that is not there at this point. We are going to give them an answer. I will give them an answer. I care very deeply about the k2 situation but it would be a disservice to say put it in a presumption because then the urgency is just not there to find the answers for these veterans. Direct Service Connection absolute put in claims, and looking at them with vba right now but a presumption is premature. Thank you for participating in todays hearing. Mr. Chairman i yield. That i thank the gentleman for the gentleman yields back or the chair now recognizes the Ranking Member from wisconsin for the purpose of introducing a unanimous consent request. Yes i would like to ask unanimous consent to place testimony from the february hearing into the record. Its just a one sentence thing so do you mind by reid it . Is for Master Sergeant carl wagner and his testimonies contradict the contradictory to what you gave us. There were no breaking and exposures no protective equip and recommended issued or employed. Thank you. Without objection unanimous consent request is granted in the document is entered into evidence. The chair now recognizes the gentlelady from illinois ms. Kelly for five minutes. Thank you mr. Chair. Thanks to the work of the subcommittee we have new evidence about the conditions that they lived and worked in between 2,012,005. In july or committee released hundreds of pages of previously classified k2 environment to assessments. These reports in 2001, 2002 in 2004 looked at several toxic exposures are according to one assessment soil testing in 2001 in that quote elevated levels of volatile organic compounds and petroleums hydrocarbons detected at numerous locations. In june of 2002 Operational Health assessment estimated and i quote between 50 and 75 of personnel strong held freedom will be explosive elevated level. In september of 2004 Health Assessment described the possibility of exposure to particular matter as frequent. Mr. Chairman i ask to enter into the record entitled health and attacks a particular matter which. Small particles less than 10 micrometers in diameter pose the greatest Health Problems because they can get deep into your lungs and get into your bloodstream. Mr. Chairman i request unanimous consent to enter into the record the fact sheet from agency for tax registry web sites between studies in humans suggest that exposure might lead to a highrisk of getting Bladder Cancer mall to mall multiple myeloma or nonhodgkins lymphoma. Dr. Hastings in your Opening Statement he testified that the va is conduct being an epidemiological study to better understand the Health Outcomes for aging veterans. The conclusion or conclusions would need to be derived from a study that would lead the va to make a presumptive connection for k2 veterans . Cement the study will look at cancer specifically but it will also look at other conditions. But look at signatory neurologic he will look at the mortality rate so it is a comprehensive look and i absolutely agree with you and with the ats that we work with very closely that particular matter is problematic as are the other exposures that are there and we are looking at all of those. What can congress do to better help these veterans prevent this from ever happening again . I think dod is very cognizant of the protections that they need to employ to take care of people before they ever get to b. A. Thats number one. When i deploy they came back and i had to do the postDeployment Health assessments just like every soldier even though im a physician. At va we are getting answers that i know that people used agent orange as the issue that was delayed. We learned a lot of things from that. We learned from agent orange. We began embarking on looking at this one was brought out in mcclatchy. We started working immediately with the Deployment Health working group and their colleagues at dod to get the adjudicated list of the veterans to make sure that we have all of the assessments and we are working handinhand. The support he can give us is exactly like this to bring it to the attention of the veterans but i will note whenever we have an airborne discussion with congress are numbers in the airborne hazards registry go up and only about 17 of the people at karshikhanabad have entered the registry. I know there are some because uzbekistan is not listed as one of the registered countries that 80 of the people at karshikhanabad or eligible for the registry and another way we can look at the deployment and their health history. The support you give us is important. You support is also at the deployment with this stated Uranium Center in baltimore and that has been extremely helpful begin at k2. A hasnt k2 created an environment putting people at significant risk including cancer and other respiratory and neurological conditions. They so we know but the hazards found is there evidence that the va could are serviceconnected and i yield back. Scene of the gentlelady yields back. I do want to rule that the gentlelady from illinois request unanimous consent request is granted without objection and the committee will receive those documents as evidence. Thank you. Id now like to recognize my friend from tennessee the gentleman mr. Green is also a k2 veteran and is now recognized for five minutes. Thank you chairman lynch and Ranking Member grothman for holding this hearing and i want to thank her words as for testifying today. Chairman lynch im especially grateful for you and for all the time and effort the deep wood into getting to the bottom of this. With 15,000 k2 veterans out there we appreciate your effort and are closer today to cementers because of you. I think everybody in the committee knows its deeply unsettling than two decades later others who were there are now battling cancer with no answer and dod and the va should by now part of the doctor who did substantial research while earning my medical degree am fully aware of the need for the studies to beat their unscientific but if we can Coronavirus Vaccines unless the near from thoroughly researched talks toxins that we know the effect of and have known the xo for many many years. I dont want to point at finger other witnesses here today. I know this was a problem long before they got to the job of these veterans need help and they need it now. The va motto is to care for he who was born the battle. We are grateful for the steps youre taking we are counting on you guys to ensure these men and women are treated fairly. We cannot leave them my brothers and sisters our brothers and sisters and director hastings said a hein. My first question recalls around some recently published information. Cbs 2 the special interviewing senior member. He was there at the time and conducted the assessment for k2. In your written testimony mention radiation was possibly not all that high but he claims quite differently saying that he saw readings higher than normal and said there was yellowcake person which neither testimonies mention. Even how the baggert he said in his comment to cbs and the notes there was arsenic and cyanide which your testimony mention. I would just like a yes or no from either of you was there yellowcake at k2 . This is dr. Dave smith. The answer is we did not find any evidence of yellowcake. Initially on the first survey that was done indicated that it was uranium material. On further analysis as you know some of those things cant be determined in the field. On further analysis it was determined that it was oxidizing depleted uranium so no there was not yellowcake and certainly its possible that he was in the First Tranche of surveyors and did not hear about the subsequent results. Just for clarification we are talking about yellowcake and we are talking about unprocessed uranium or lowerlevel uranium. So we are talking about . We are talking about depleted uranium could yellowcake is enriched that would basically be part of where you are trying to enhance the characteristic. Its a precursor to a weapon, right . Thats right. C to your wariness was there any yellowcake at the site . Again in looking at the information that was there, there was uranium. The supposition was that was yellowcake but it was not. It was rusting or oxidizing depleted uranium and the yellowcake was not there. Thank you for sharing that. Dr. Hastings in your written statement you encourage veterans to receive testing and not suggesting this is your fault but i have a document from the va from one of my constituency went to the va. In reading over the document from the va on explaining what happened to k2 and the potential risks that those veterans are exposed to it seems to me and i can get you a copy of it but it seems to me its sort of downplays the need for these veterans to get the test for that like to know from you that there is a commitment that every veteran who asked for that test gets that test. Yes. One of veteran asked for that test we have the depleted Uranium Center. The test is done by the joint center or the cdc could veterans can come in and get that test for desai said the 6500 that we have done for people that were exposed in the gulf war in 37 of which 25 have been completed all of the negative except for five in the first gulf war and that was related to shrapnel. They were negative so i believe. I understand your sample size is such that it is and the document that i saw it seems to discourage, seems to tell the va staff how to discourage veterans from requesting a prodigious want to know. I would like to see that he does i would like to see but i would not discourage it and in fact we encourage it at this peace of mind is important. Thank you. The gentleman yields back. I thank him for his questioning or his service. The chair now recognizes the gentlelady from virginia who is also the chair of the va subcommittee on disability assistance and as well as United States navy veteran. You are now recognized for five minutes. Thank you chairman lynch and thank you to the Oversight Committee and subcommittee for allowing me to participate today are just the chair of disability Veterans Affair and on the military subcommittee and variances in this issue could im glad to have the opportunity to speak with our witnesses today. I would like to request a minimus consent to enter the record to this one that ive recently written in response to secretary wilkie at the va and the former secretary aspers a spur providing responses on this issue. Without objection, so ordered. It like to address an issue of trust. Even in the responses to these letters and coupling that with the testimony reefer said today theres an enormous amount of conflict of information being for minor with the issues of toxic exposure that we are dealing within the Veterans Affairs committee and provided health care is too additional veterans for their exposure to agent orange extensively investigating the issues on the k2 issue it seems that there is information provided to veterans that does not instill trust in the system with india the health care and the va and the like to cite several things here they were provided to me by secretary espers response. One of those is civically concerning a vice provided to Health Care Providers in addressing the concerns of k2 veterans and although this is an unstated document is assessed in her mark that was the approximately dating from 2001 or 2002. What can i do to build trust and rapport . This is a provider to the patient concerned about exposure to k2 in this army says the most important messages to communicate our one there were no k2 exposures or Health Consequences are the protected residual measures were effective and show care and commitment during Clinical Care ongoing monitoring and continued protection. Basically they told the veterans dont be worried about it and then i found this other document from the army Public Health center and it says you did not need to get a medical examination or have any additional medical screening because of k2 so our veterans watching today who have concern about this the information that provided is directly in conflict to what youve been discussing today. Dr. Hastings specifically said there was no evidence that secretary wilkie responded to the letter in and the Oversight Committee however have here what i was provided by secretary esper in july of 2015 Army Medical Department journal which specifically states that this is an important topic which is where the Public Health efforts and resources gives the same physical data given about the types of cancer with increased incidence and sustain statistical data in the church we discussed today. Id understand your response there. I would like to shift further to the fact that dr. Hastings in your testimony today your written testimony doesnt does there have been environmental samplings for soil quality but you dont address water in here at all and then when i referred back to a document that i was provided by the department of defense and Monitoring System for 2,012,005 and k2 it does address water. In that it specifically says both shortterm and longterm health risks they talk about the sampling that was done. It actually contradicts itself is assessed no samples were taken from water that was purified by reverse osmosis units and concerned the contaminants were not violated however the it says they did take samples from that. Long story short if this could be entered into the record is this is confidence in the Risk Assessment about water was shortterm and longterm Health Concerns is can you address why you did not address anything related to water because we are talking about fuel contamination in the soil and uranium in the slippery than not environmental scientist or a doctor but my understanding is that we are using the source of groundwater these things the chin to groundwater they should we closely scrutinized for the water that people are using for nonportable water sources as well as water purified by reverse osmosis units because that processes left effective less effective than the distilling process and what water samples were taken and what further analysis was done on the water and information for k2 . C i would like to take that for the record and gave you a complete answer. The water that is used in deployment as you know from being in the military is very important and in many cases it is bottled water but i need to investigate that to get you complete answer. It says this reference refers osmosis units were used for probable water so i would be interested in seeing your followup testimony. I will take that for the record today. Thank you. If i could add there were multiple reports of the water tl reports actually did test the Potable Water and bottled water and all of them said there were no concerns related to Potable Water but we will provide you Additional Information on that. I would be interested in that because i will back what the study says. Its the conference and the risk estimates about probable water flow and this is a study reviewed by centcom in approved in may of 2011 by the u. S. Army so i would appreciate any followup additional studies have been conducted. Thank you again to the chair for allowing me to participate in and i yield back. The general lady the gentlelady yields back. I point out in the Foundation Report provided to the committee there were three or 45 claims of Neurological Disorders as well as 397 cases of Neurological Disorders among k2 veterans. That might also support the questions and that this is that the gentlelady from virginia has put on some of these reports. I do want to amplify that some of these on the ground reports and assessments were given a low level of confidence in terms of the threat that was present on the ground. With that i would like to recognize the gentlelady from North Carolina ms. Foxx for five minutes. Thank you mr. Chairman. My first question is for dr. Hastings. Has the va determined whether longterm Health Problems and k2 veterans arise as after serving on the k2 base . That is one of the things that the study will address. At this point that veterans if they believe the military service has negatively impacted their health that they proceed with the claim for direct Service Connection. At this time without the study we cannot say that there is an association produce you know many of these veterans deployed to many other locations also and thats the reason we have one that was to play to oef but not to k2 and the other that is in the oef era but not deployed to k2 or oef. That is what will give us the answers. Dr. Hastings im over to your left. Im right up on the dais. Oh im sorry. Over here. There you are. Is there evidence that demonstrates a k2 veterans are not suffering Health Effects as a result of their service on the k2 base . Now and thats the reason we need the study. Are there any other viable explanations for the large number of toxic exposures and servicemembers who time at k2 . Yes. Veterans are exposed to many things during their service and as ive noted a couple of times before 59 of the k2 veterans have turned in a claim for the majority of those claims are for musculoskeletal issues. Im specific way looking at those issues that are of concern to this committee and the study will give as many of those answers. Dr. Smith is it true that in 2001 a Health Assessment down that ambient air and k2 was the main concern for environmentally contaminants and found elevated levels of volatile organic compounds in Petroleum Hydrocarbons throughout the base . No maam. The 2001 survey did find elevated volatility in the compounds in subsurface when digging and they are clearly early on was an incident with you becky contractors where they were digging to. A berm where they ran into one of the underground plumes and certainly folks had acute Health Effects at that time that were the contractors, that prompted a fair amount of additional survey. There clearly are volatile organic compounds that were found. None of them at the exposure levels that im aware of in these surveys that were done in 2001, 2002 and 2004. To follow up on that is it true bet in a 2008 Health Assessment found between 50 and 75 of kirsanow on the k2 base would be exposed to elevated levels of toxic contaminants . I believe the 50s 75 was related to the fact that there was an issue which we find throughout southwest asia of particulate matter in the air so dust and certainly that is a risk in that part of the world and it clearly does exceed what we consider to be exposure limits that we have set in the United States but its a reality of those deployments. What does Congress Need to do to ensure all eligible servicemembers and veterans receive the Health Benefits they are entitled to . Clearly thats not in the dods claim as farce ultimately to determine that unless they happen to be a retiree. I will say relatives of the particulate matter this has been a concern for a while. We have a number of studies that have been looking at that. To date its primarily respiratory related and for individuals who have a preexisting condition because of their makeup. But the studies have looked at this very carefully and we continue to study the issue. Thank you mr. Chairman could i yield back creates that the generally deals back of the chair recognizes the gentleman from arizona mr. Go sar. You are recommended recognized for five minutes. Spent the chair recognizes this woman from texas mr. Cloud for five minutes. There he is, okay. Hello, hello, hello hello. Can you hear me . We certainly can. Please proceed. Thank you chairman for hosting this hearing on this extremely important topic and thank you for your service as well. This of course is an extremely important topic to all of us who care about the men and women who serve to protect their country. Of course the great concern is while we want these decision to be sciencebased and a concern if the science takes so long to develop that its a mute point of not be able to help those are the same that happened tragically in the past so dr. Hastings could you speak to the process of how you have come to these conclusions. When do you get to the Sticking Point so to speak when you, when you are able to balance the okay we have the information we need to make a decision here as opposed to come as opposed to continuing to get the science so exact that i cant help anybody because it takes so long. We are talking a couple of decades now and how long does it take for these 2 . Can you speak to that please . First ill ask how long does the tape for the simpsons to exist . Sometimes it can be minutes but with some of the cancers in the things we are looking at there can be a latency period as you know. With regards to studies the model that is used by the National Academy of science and jenae and medicine looks at five levels. There is a level from causation all the way down to no evidence of an association. In most cases causation is pretty hard to get to and we dont look for causation. Thats a very high bar and in fact the National Academy of science engineering and medicine uses it for exposure and i wasnt looking at fuels with regards to benzene and the cameos. In most cases for example the agent orange presumptions most of those are evidence of an association or possibility of an association and so we are really looking at association. I dont think what this would get to causation and if we did that would be surprising. We are looking at associations. In my district when the issues that have come up which is not exactly a singer related his the families affected i exposure and in this case we have a registry that while the research has been ongoing there is a registry where people can register but can you talk to what youve done in the web make them sure that veterans have a way i know a number of them have made claims are ready but would be doing practically to connect with veterans and inform veterans of their exposure . We do a lot of outreach. We have the web site that we use could be sent letters and many times of the guard to airborne hazards specifically we work with dod. D. O. T. Sent out electronic as well as hardcopy letter notices to anyone that may be eligible for the registry to encourage them while they are on active duty if they have been an area eligible for the registry to make sure that they do apply. We do the same thing in the va. We send out letters. We encouraged people to apply could one of the things that you did here in congress for us last year was you gave us funding to do more outreach and at this point in time we are working with the funding that you gave us to put together a comprehensive plan to do more outreach to veterans in this would be through podcasts radio spots as well as changes to the web site. You mentioned 59 of the claims were musculoskeletal. Can you break that down . Im sorry 59 of k2 veterans have submitted a claim and the majority of those are musculoskeletal. I would need to take for the record any further right down. C okay. We could get that, that would be nice. Thank you mr. Chairman. Seen it the gentleman yields back rethe chair now recognizes the gentlelady from california ms. Speier who is the chair of the house Armed Services Committee Subcommittee on military personnel and someone who has done a lot of work and is keenly interested in the hull thing care and protection of our veterans as well as our active military cell ms. Speier you are recognized or five minutes. Im not sure if you are muted. Okay, we see you. Ms. Speier you are now recognized. We might have a technical issue here. Apparently ms. Speiers audio is not working. While we are waiting to solve that technical issue i would like to do a followup question. As i recall the va announced it would conduct a new epidemiological study to assess the Health Outcomes of veterans and dr. Hastings u. N. Your Opening Statement testified that this new study would take the fort between 12 and 18 months to complete but i do want to note its been almost seven months since the va told the subcommittee plan to conduct the study. So doesnt still need 12 to 18 months or you baking in the six months that we have already or the seven months that we have already engaged . I will tell you we are doing it with a very small staff at this point in time. We are working with dod so at this point in time i would say by next lets see by next december is when im hoping we would be able to give you at least preliminary report on their findings have not completion. Stack has the actual study started yet . Guest . Its beyond design. It gets beyond design and we have made the cohort selections period okay. I welcome the Additional Research if we can lead to faster diagnosis or improvement of Treatment Options for veterans but im just very concerned we might reach a point where we have a study that gives us and conclusive results again while we still have these veterans suffering and without their rightful benefits. He did refer a number of times to the va study is being prospective come a prospective epidemiological study. What do we mean by that . This is not going to be a one and done. This is going to be a study that has started now looking at the complete group but it will go into the future. That is very important to some of the diseases that we see that are of concern. C okay. Dr. Matthew noted that dod has provided the va and this is a quote a complete list of individuals who deployed to k2 as well as other background material and environmental assessments. With the objection of the roster because i understand you provided highlevel numbers of privacy considerations to the Background Materials and environmental assessments that you mention include additional documents or information beyond what d. O. T. Has provided to the subcommittee . Whats the universe we are talking here . Im not aware of additional documents but i will look back to my expert in math. Thats what they have received and we are working hand in glove with them to try to make sure because they will also have all the Health Records and the information that we have postDeployment Health surveys etc. To help fill out the study to make sure all the information that is available is available to them. We appreciate that doctor. Im not sure if we have ms. Speier back on line again. I would like to welcome her again. Ms. Speier is the chair of the House Armed Service Committee Subcommittee on military personnel and a great partner of ours on the subcommittee and someone who is as i say keenly adjusted in the Health Welfare protection of our troops are active military and our veterans so with that i would like to yield five minutes to ms. Speier. Contaminated soil was used to build a berm around k 2. Constant floods disbursed the soil around the base. Any. O. D. Did not mitigate risk and the work and living areas of k 2. Close quote. P would you agree that it is possible the armys mitigation measures were not effective at preventing toxic exposures . Thank you for the question. I have to rely on the evidence that we have. I do not have any evidence to say they did not do it within the first couple of weeks of deployment, this is when a number of these things were uncovered. Remediation clearly didnt get so the completed until a number of weeks. But certainly the followon reports et cetera had validated the recommendations they made had been implemented each time you do one of these surveys you may find additional items that need further remediation. But i did not have any evidence to suggest that they were not done. That need further remediation. But i did not have any evidence to suggest that they were not done. If you were given additional evidence, would you then review it and incorporate it into your study . Yes, absolutely. Forgive me, i did come in late. The story is going to be completed within 180 days, or not . No man, i do not believe it will be done in 180 days because we want it to be thorough and scientifically rigorous and i do not think that that is realistic. So, have you given the committee and the idea how long it will take . In my testimony i was suggesting that it would be somewhere between 12 to 18 months. I would expect certainly by 22. Doctor hastings and doctor smith, what more can the dod do to expedite the health car healr these veterans whose conditions might be related to their military service at k2 especially during the 12 to 18 months that you entered . In many cases veterans have access to the delivered healthcare. They are able to come to the va to register for healthcare if they have not. If they have a serviceconnected illness they also if they got out of the military within five years they are eligible to come to the va. And if they have transited through a combat area, they certainly are eligible under the combat eligibility listing. And again, any military service that may have negatively impacted their health, we encourage them to put in a claim, and 59 of the k2 veterans have done that so far. And youve been in communication with the other veterans about the potential risk that they may have experienced . We have been in contact with some whove contacted my office. We do have a website. We have that available for them to look at. We do have depleted uranium websites also and they are able to get tested for depleted uranium. You may have missed this, but we have had 25 k2 testing is done for the signature of the depleted uranium. All of those have been negative. We have 12 more that are waiting to be completed either the joint Pathology Center or the cdc. This is a test that takes an analytical chemist a phd with very fine instrumentation. We have done 6,500 of those for people involved in the gulf war, all but five of those were negative and those people have shrapnel injuries. We do have 84 other veterans that have shrapnel injuries from the gulf war that we bring back every two years to look at and examine, and they are doing well. They have no excess morbidity and mortality in that group over what you would expect. Thank you, doctor hastings. My time is expired. I would certainly recommend that if theyve already identified that 60 of the veterans have been identified and have come forward, it would make sense that we should communicate with the remaining 40 of the veterans whove been signed to k2 to alert them to potential risks that they may have been subjected to and may be begin to that for an nda so they are aware. I think they are expecting a lot when people are trying to survive today. Thank you and i will yield back. I think the gentle lady. Her point is well received. In questioning from the gentle lady from virginia, we did have records of letters from physicians who indicated that notification to the 40 so to speak was not given, they were not advised that they should be alerted to the possibility of medical conditions arising from this service at k2. So, i agree with the chairwoman of the house Armed Services committee on military personnel that we should make that notification official and we should try to expedite it in the next available legislative vehicle. So, i welcome her participation in that and happy to work with her. I am told that we have mr. Gose are back online so i would like to recognize the gentleman from arizona for five minutes. Thank you mr. Chairman. Sorry we had a failure with the audio. But thank you for calling the hearing and being so close to veterans day i want to thank all of the veterans for their service. And may be looking at this in a little bit of a different light. Trust is a series of promises kept, and i think that is where we have to start by looking at this analogy and making sure that we are actually engaged with the veterans, so now between the fall of 2001 where the troops were first deployed to afghanistan and 2005, is pakistan and withdrew. Its estimated a 10,000 10,000 individuals served at k2. But they are now having concerns that it may not be accurate as it may not include those troops which served at k2 on a temporary assignment or may not have identified troops that were there is classified. Doctor smith, does the dod having an accurate accounting of how many u. S. Troops served in the base while it was in operation during the early war in afghanistan . Sir, we continue to comb through and look. As i mentioned in my testimony, through the run we added to the number we are now at 15,777. Its what we have in the records today but we are doing Due Diligence and continually looking for so, have you got basically try to outreach to make sure they know they have a possible exposure . Sir, i am not aware of the specific outreach. We do as you are probably aware post deployment assessments for all of our returning Service Members and also clearly advertise that we are available to discuss if they have any concerns associated with their deployment at any time. I think that going even further the gentle lady from california started bringing this up, depending on the veterans, it would be nice for us to engage. So, shouldnt we be reaching out as well . This is doctor hastings. I do have a letter that we had planned on sending out in july. However, because of covid, we have not sent it out and it was advising them about where they could go to look for Additional Information. It spoke about the possibility of a depleted uranium test, and so i have the letter and im happy to share it because of covid it wasnt felt to be wise to send it out at this time because the danger of covid specifically for a urine test would be problematic, but we certainly could send it out and just ask them to wait until it is a safer environment and give them the information with regards to the website that they could get information from. So, is there any way that or a system that exists to identify these individuals like in the states and districts like im from arizona, so we had a big population. Is there a way that we could utilize the state number so that they have an additional way of contact, and then maybe hit on the head of the game instead of always trying to catch our tail . I do not know if it would be able to get down to the district level. I can look at that and take that for the record. Every member here is the constituents of the veterans i think that its building that trust that is so in need. But i thank everybody for coming and its very timely on the call for the hearing and i think we need to keep our foot on the gas pedal to make sure that we are honoring our promises to make sure that our veterans are healthy, wealthy and wise. Thank you mr. Chairman. I think the gentle man. Let me just ask as a followup to the inquiry how is the va contacting veterans regarding the study . How has that been facilitated . We have the complete list, and we are able to look at the various databases. One would be the mortality data bank that comes from the national databanks from mortality. We have cancer registries et cetera. We actually do not need to contact the veterans specifically. We can look at their medical records. We can look at the different databases nationally to look at their Health Conditions. But when we look at the numbers that have selfreported versus the ones youve diagnosed, this is a much larger number that has selfreported. And studiein studies like th, selfreports often we would have to investigate those further because selfreport may not be accurate. How would you know. If you miss it you are not communicating with the veterans and they are not self reporting, then they are not what i am saying is that if you have a veteran out there that is having medical problems, and they know that theres a study going on at the va regarding people of serving where they served and others issues, then that would be helpful that they know about this. We want them to get the medical care that is required. But we really are not looking at the care and treatment. We are looking at the conditions and so we would not need the veterans sending medical records and that sort of thing. We are looking at Health Outcomes. Im just trying to make them aware of the study. Absolutely. And in this letter that i am happy to share, it does the one we have not sent out yet. We have not. But we know because of covid that all of these appointments are being stretched out because we cannot process them like we would under normal circumstances and that is understandable. However, some things can be done through telehealth methods. I know they are doing some of that at the va where the Service Members are not coming in for treatment, but theres telehealth appointments being made so they can get information back and forth. So, i would encourage you with all dispatch to get that letter out and we will just have to deal with the backlog of the cases in terms of appointments but its good to get them on the books even if we cannot conduct them in the short terms we at least plan to. We will make the commitment to get the letter out it doesnt work very well when you are asking them to bring in a urine specimen, so i will change the verbiage for that and ask them to wait on that portion until after it is a safer environment. But i will make the commitment to send the letter that lets them know there is a study that is going on and lets them know where they can get Additional Information. Thank you. Do we have any idea once the study is completed how long between the completion of the study and a decision on presumption or no presumption . I would hesitate to speak for the secretary, but if the secretary has strong science, the secretary is able to make those determinations. Okay so we are not quite clear on that. Okay. I believe that concludes the number of members desiring to testify and answer questions. Let me in closing i want to thank all of the members. I know that there are several hearings going on and other things going on, but im very pleased with the number of members who took the time to participate in this hearing and i want to thank the Ranking Member from wisconsin for his leadership as well. I want to thank the panelists doctor hastings and doctor smith, thank you for the service to the country and willingness to come before the committee and help us with our work. This is a very important conversation, and a very important process. With that and without objection all members will have five legislative days to submit additional written questions for the witnesses to the chair. This hearing is now adjourned. 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