And others will appear remotely. Sie some members are appearing in person, let me first remind everybody that pursut to the latest guidancerom the house attending physician, all dividuals attending this hearing in person must wear a face mask. Members who are not wearing a face mask willot be recoized. Let me also make a few reminders for those members that are appearing in person. You will only see members and tnesses appearing remotely on the monitor in fro of you when they are speaking in what is knowas active speaker mode. A timer is visible directly in front of you. For the members appearing remotely i kw that you are all aware by now. But let me remi everyone of a few points first. You wille able to see each other speaking during the hearing. Whetr they are in person or remote as long as you haveour web said to active speaker mode. If you have any queions about this actation, please contact the Committee Staff immediately. Second, we have a timer that should be visible on yr screen when you are in active speaker mode with a thumbnail view. Third, the house rules require that we canee you. So, please have your camera tued on at all times. Fourth, members appearing remotely whore not recognized should remain on muteo minimize background noise and feedback. Last, i will recognize members verbally. But members maintain the rig to seek recognition verbally and in regular order mbers will be recognized in seniority order foruestions. If you want to be recognized outside of regular order, you may identifyhat in several ways. You may use the chat function to se a reque. You may send an email to the majority sta or you may unmute your microphone to seek recognition directly. Obviously we do not want people talking over each other so my eference is that we usehe chat function or email to the extent possie to facilitate formal and verbal recognition. Committee staff will ensure that i am made aware of the reques 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 celebred veterans day to honor the brave men and women who were sworn to protect the unid states throughout the nations history. Our country owes them all a solid debt of gratitude. Too ofte however, when our sons and daughters in uniform have returned home with the scars ofhe war, our government has failedhem. From agent orange in vietnam to the toxic exposure from the burn pits in iraq and afghistan. Our nations veterans have repeedly sought the acknowledgment of their injuries and assistance from washington only to be met with resistance, skepticism and doubt. This story is regrettably playg out once again for the soldiers, airmen, marines and national grdsmen who deployed to karshikhanabad better known as k2, which is a former soviet airbase in s pakistan on the afghan border. That the u. S. Forces used to support military operations in afghanistan following the september 11th trorist attacks. Between 2001 and 2005, morehan 15,000 men and wen deployed to support the Operation Enduring freedom and declassified assessments conducted by the military at the early 20s the 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,articulate 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 wl 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 fin an appropriate time to hear from the senior va policymak even athis la date. Without signifint support from both your departments, any congressional effort to make e veterans whole after the attacks on september 11the deployed the units to k2 and hisakistan in preparation for the invion to afghanistan. Andith the soviet base unfortunately with serious toxic risks and we kneof those toxic risks as i understan it before we deployed the troops there. We heard stories of black sludge coming u from the groundnd contaminated soil throughout the base. Since it waslosed thereve been numerous illnesses and deaths reported from those who served and we will askome 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 rosr would make muchneeded transparency and help congress mak determinations quite frankly conducting 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 operatnal Health Risk Assessments haveeen declassified and they show multitudes of toxins the Service Members could be exposed to incling jet fuel and radiation. Shockingly, these arguments of the previous testimony showed that the military leaders didnt communicate the risk with a statio there despite being instructed to do sohich is callousness. I fuy understan but i hope that you feel as we do that we owe a little more attention to the peopl 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 encouragin the veterans to speak up and come to the va to sk treatment. The subcommittee willontinue to fight for all Service Members that were statied and we cannot affd to sit idly by as they put their livesn the line for this country and continue to get sick. I he everyone including the press will do what is best to move forward and thank you to the witnesses for being the. 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 isy top priority and remains t top priority for the department. Thank you very much. Doctor hastings, you are now recognized for a verbal presentation. [inaudible make sure that ur 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 yr 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