Statement of Julia Dyckman

Captain, USNR, RN, MPH

before the Institute of Medicine,

National Academy of Sciences

December 15, 1999

I would like to graciously thank the Committee for allowing me to make my statements on the "Health Effects Associated with Exposures During the Gulf War." My name is Captain Julia Dyckman, United States Naval Reserve - TDRL. This means that I am temporarily medically retired due to an illness that occurred during my service during the Gulf War.

At the time of the Persian Gulf war, I was a Commander in the naval reserve that was activated January 16, 1991 to serve at Combat Zone Fleet Hospital 15. Fleet Hospital 15 was a 500-bed hospital with 948 personnel including the construction battalion units. It was assembled at a site west of Al Jubayl, Saudi Arabia. Before leaving for this duty I was in excellent health, having just received a physical prior to being mobilized. While in Saudi Arabia I began with the initial symptoms of uncontrollable tachycardia and open skin sores and lesions. These were the forerunners of what later became an increasing number of diseases. Thus far I have been involved with various treatment protocols without success. Many have been involved in the search for the etiology of this illness, again without success. I have testified before congressional committees on problems associated with the Veterans Administration system in the diagnosis and treatment of Gulf War veterans, which has resulted in some small changes to its bureaucratic maze.

I understand that your task is to review existing documentation and present recommendations for additional scientific studies. I know that you are NOT charged with defining an etiology for Gulf War illnesses or defining those illnesses. However, I feel that it is IMPERATIVE that you define the all-encompassing disease experienced by Gulf War veterans. By now you must be aware that an undiagnosed illness serves no logical purpose other than to confuse the medical establishment. Your "stamp of approval" of a name and code for this disease is essential to the veteran obtaining the best possible medical care.

It has already been stated that there is no new single disease. However, research has adequately shown that most Gulf War veterans have symptoms that involve several organ systems simultaneously. These symptoms are consistent and unique as a whole package. The whole Persian Gulf war experience has produced health consequences that are defined by this package or combination of symptoms.

The Gulf War, because of its unusual characteristics of dealing with depleted uranium in combination with pesticides, insecticides, chemical and biological warfare agents, vaccines, PB, heat stress, solvents, paints, fuel, smoke from oil well fires and sand, has produced a Gulf War Syndrome, not an undiagnosed illness. This syndrome is singular and not easily confused with other syndromes or illnesses.

It is ironic that the medical establishment in the form of Tabor's Medical Dictionary and the Merck Manual have a definition of Persian Gulf Syndrome but the Center for Disease Control (CDC), Department of Defense (DOD), and Veterans Administration (VA) do not recognize it as a disease.

A diagnosed disease has an ICD-9 code, an undiagnosed disease does not. We cannot continue to deal with an undiagnosed disease because an undiagnosed disease is not considered a "REAL" disease.

A "real" disease is coded and named. This coding and naming allows patients to be tested, treated, covered by insurance and even possibly compensated. According to the VA approximately 202,000 claims have been filed for compensation by veterans of the Gulf War. However, most of the veterans are NOT treated by the VA and, in the case of reservists, are not eligible for military care. Therefore many veterans are not being treated by the Veterans' Administration but by private physicians under Medicare or private insurance.

Medicare or private insurance will NOT pay for an undiagnosed illness, it will not pay for screening tests of an "unrecognized illness." Physicians are not paid by insurance for treatment of undiagnosed illnesses. Many physicians are reluctant to treat multiple symptoms in an unrecognized illness that has a bizarre number of symptomology. I personally have been rejected by at least three separate physicians since they do not know what constitutes "Persian Gulf illness" or how to treat it. Those physicians who are willing to work with us are hamstrung by not having a proper ICD-9 code to put as a diagnosis, hence they have to individualize the diagnosis by considering each symptom separately as opposed to looking at the body as a unit. This is the only way they can be paid by insurance for treating you.

I am asking how measurable evidence can be ignored. Let me explain:

• I have received 26 separate diagnoses of diseases from the U.S. Navy including all the "normal" ones associated with service in the Gulf War. I am rated as 90% disabled and have been placed on the Temporary Disabled Retired List (TDRL) as the Navy hopes that I will make a full recovery and be able to serve my country again. This rating was based on illnesses that originated during my service in the Persian Gulf; yet I do not have the title of having "Persian Gulf Illness."

• You already have evidence about chemical weapons that were discovered at Khamisyah and when its cache was exploded it resulted in heavy environmental debris. Yet, it is impossible for a veteran to prove to anyone that they got sick from such exposures even though it has been known for decades that low levels of organo-phosphates produce permanent health changes in a significant number of people.

• You already have proof that unexpected depleted uranium residue was found on equipment, on the battlefield and in people's bodies. Yet it is stated that these abnormal levels are not a health concern even though zero levels is the only true normal.

• Recent research has shown that PB tablets under certain conditions can cause an abnormal reaction that can be defined as an illness or disease. Yet, veterans have been told that PB is not one of the probable causes of their illnesses. How can it be determined that it is not a probable cause of illness?

• Troops were given secret shots, the shots were recorded in logbooks and the books subsequently lost or probably destroyed. The shots were never recorded in medical records. Does this mean that the shots were never given? Along with this, research has shown abnormal levels of synthetic squalene in the blood of people who are ill and received these secret shots, yet NOT in the blood of those who did not receive the shots. Until recently a veteran could not prove that he received the shots. Now, after many years, research has provided a definitive test to measure the amount of synthetic squalene in blood. Now veterans can prove that they received the shots. However, many researchers are saying that squalene is not a contributor to the existing illnesses experienced by Gulf War veterans. Strange that a measurable commodity is not a contributor to illness but unmeasureable commodities are "possible" contributors.

• According to the DOD it was documented that in Al Jubayl, Saudi Arabia, Seabees shirts changed from brown to purple. This was attributed to an industrial pollutant from a nearby chemical plant. How can it be assumed that no adverse health effects occurred from this "pollutant?" The shirts didn't change back to brown, so why is there the assumption that there is no permanent damage to the body?

• The Veterans Administration is spending approximately $20 million to do antibiotic treatment of "undiagnosed illness." What are they treating for......mycoplasms? ....biological weapons?....what? If you don't have a disease, you can't treat it. Is it because antibiotics have been shown to reduce the symptoms associated with this "undiagnosed illness" or is this just a huge and costly blind study?

These studies, tests, and occurrences are evidence that the disease does exist. Yet, there is no code, which means...there is no disease, there is no illness, and there is no syndrome.

How can you recommend additional scientific studies if we are not dealing with a real illness. People are dying from a real illness, not an undiagnosed illness. At the end of 1999 you need to fully admit that 1991 happened, that the Gulf War was a real war and that it had real health consequences that are continuing today.

I had some trepidation in presenting this request before you because "you have not been tasked to name this illness." Military protocol requires appropriate labels of identification. In this case an appropriate label is required to insure just treatment and eventual compensation. For that reason an inappropriate negative label of "undiagnosed illness" must be changed and eventually coded.

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