The US experience
93. The US has nearly 700,000 Gulf veterans and over
10 per cent of them have completed health examinations through
the Department of Veterans' Affairs (VA) or the Department of
Defense (DoD).[215]
In financial year 1997-98 alone, $121 million was spent on research
into Gulf War illnesses by the three relevant departments, DoD,
VA and Health and Human Services, the vast majority being spent
by DoD.[216]
The work of the three departments is co-ordinated by the Persian
Gulf Veterans Co-ordinating Board. The MoD has a full-time Gulf
Health liaison officer based in Washington DC, who participates
in the Co-ordinating Board's Research Working Group.[217]
The General Accounting Office (GAO) has recently produced an assessment
of the research undertaken to date.[218]
94. The situation for US veterans is not universally
better than for UK veterans. Dr Rokke, himself a veteran of the
Gulf conflict who suffers health problems, told us—
We have senior officers throughout
the entire military in all branches of service in the United States
that are sick, but if they go for medical care and then they are
identified as being sick or they go and apply for some compensation
or pension, their career is over.[219]
US veterans have experienced problems in obtaining
treatment because of the need first to obtain a 'line of duty'
document—
The line of duty documentation
verifies that your illness, injury or sickness was caused by duty
during military service ...An individual, unless he has a line
of duty, cannot get care from the VA or the Department of Defense,
so when they go there and they have a problem and it is Gulf War-related,
first off they cannot get care and then the next thing is they
cannot get adjudicated ... there are deliberate attempts to avoid
providing medical assessments and medical care for individuals
... what you end up with as to the compensation or the pension
is none or, if you are lucky, you have to fight all the way through
the bureaucracy to get it. ... when the majority of people came
back, the United States had no line of duty report prepared, so
there is no way for them, first off, to get medical care, and
without medical care, there is no way for them to get an assessment
and without an assessment, there is no way for them to get a pension,
and all that happens is they die.[220]
Unlike British Service personnel, US personnel are
not entitled to seek legal liability compensation from their government.[221]
95. We have taken the opportunity during our visits
to the United States to update ourselves on developments there
in relation to Gulf veterans' illnesses, most recently in October
1999, when we had useful meetings with representatives of the
VA and the GAO. The GAO view when we discussed the matter with
them was that veterans' illnesses were likely to be immunological.
This might explain why some veterans are ill and others are not,
despite similar exposures, as individuals have different immunological
tolerance and will react differently to the same exposures. More
work could usefully be done in this area and on the possible effects
of multiple exposure to many low-level factors. The GAO expressed
the view that treatment and alleviation of symptoms were more
of a priority than epidemiological work. The burden of proof in
the US now lies with the Department of Veterans' Affairs to prove
that symptoms have not resulted from service in the Gulf.
96. We were told that two compensation programmes
operate in the US: any veteran can apply for compensation for
service-related illness which begins during or within one year
of service. A scheme unique to Gulf veterans has also been set
up whereby compensation is payable for chronic illness (lasting
for six months or more) resulting in 10 per cent or more disability.
Levels of payment depend on the level of disability, which is
assessed every two years. Veterans are eligible to join the scheme
until 2001.
97. In its recent report on US research into Gulf
War illnesses, the GAO commented—
Problems identifying valid
data on veterans' exposures persist, and basic questions, such
as how many veterans have unexplained symptoms and whether those
who have received care in VA facilities are getting better or
worse, remain unanswered ... Even though significant funding has
been spent on research and investigation of Gulf War veterans'
illnesses, most of the research is ongoing ... little knowledge
exists concerning the causes, courses, or successful treatments
for Gulf War veterans' illnesses.[222]
However, useful work, both in research and treatment
is in hand. A project sponsored by the Department of Health and
Human Services, which began in 1997 and due to end this year,
is assessing the persistence and stability of veterans' symptoms
over time. The VA and DOD are recruiting volunteers for planned
trials of antibiotic and exercise-behavioural treatments for veterans
with unexplained symptoms, although the lack of understanding
of the physical causes of symptoms means that such treatments
are more likely to ameliorate symptoms rather than eliminate them.[223]
215 
