interviewed by new yorker staff writer, susan. watch book tv every sunday on c-span2 and find a full schedule on your program guide or watch online anytime at booktv.org. ♪♪ >> first lady in their own words, eight part series looking at the role of the first lady, their time in the white house and issues important to them. >> a great advantage to know what it was like to work" because education is an important issue, both for the governor but also for president so that was very helpful to me. >> material from c-span's award-winning's biography series first lady. >> i'm the kind of person who believes you should say what you

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>> we're going start on time, then we're going to go back and forth -- [inaudible] [inaudible conversations] >> okay, thank you. good afternoon, everybody. the subcommittee meets today to receive testimony on the hea >> afternoon, the subcommittee meet today to receive testimony on the house effects of exposure to airbornect hazards including toxic fumes from burn pittsburgh

let me start by welcoming ranking member tillis who will be here shortly, an excellent partner on the subcommittee over the last several years. senator teller and i shared a commitment to supporting service members and providing the services resources and care they need. the commitment extends to shared drive to a address debilitating extensive disabilities caused by the use of burn pits and recent combat operations. those risk should not come from the operations of our own bases, and when they do, we must take responsibility. i look forward to continuing to work together on this issue. i was also glad to hear that president biden prioritized addressing this cost of war in the state of the union and again in texas last week. he described the clear cause and effect of this crisis saying, quote: the burn pits that incinerate the waste of war, medical and hazardous material, jet fuel and so much more were just dug in big pits not far there from where our veterans were sleeping. and when our troops came home, the pittest among them, the

greatest -- fittest among them, too many of them were not the same. headaches, numbness, diss dizzy -- the dizziness, cancer. men and women who deploy at the peak of physical fitness are now fighting to survive. this is the, this is a health crisis among our armed services. most public attention on this issue has been focused on the treatment of veterans at the veterans administration, but these health issues stem from time on active duty and can begin presenting while our troops are still serving. the dod has a critical role to play in protecting the health of our current and transitioning service members. that's why today's hearing is so critical. finish i we need to have a better understanding of how toxic exposure has been and and is being tracked and documented, and the barriers that have prevented that documentation are from being done effectively. congress has already recognized dod's responsibility and has passed legislation to require dod to take appropriate

measures including requiring inclusion of exposure to open burn pits in post-deployment health assessments of service members returning from deployment, recording burn pit legislation and electronic health records and mandatory training for military health care providers on the effects of burn pit exposure. but we need to go further. we need to build an understanding of the health impacts of toxic exposure and our knowledge of when such exposure's a occurring, and we must make that available to service members, their families and the medical professionals they rely on in order to properly and adequately care for our troops who have been exposed. as president biden said, quote: we need to know more about which of our veterans may have been exposed to burn pits in the first place or other environmental toxins during their service and or record possible exposure before service members separate from the if military. edge quote. today the's witness -- end

quote. today's witnesses will help provide clarity in both of those areas. our first panel is witnesses who will testify about the health effects of toxic exposure, documentation of potential exposure and monitoring of exposure. witnesses on our second panel will share what they have seen or experienced firsthand on this issue and will provide recommendations for insuring the health and safety of our service members. witnesses for our first panel include dr. terry m. rauch, acting deputy assistant secretary of defense for health readiness policy and oversight. dr. raul mere sa, environmental medicine clinical public health and epidemiology, u.s. army, colonel adam newell, chief of medical readiness, air force medical readiness agency, and captain brian feldman, commander navy and ma if lean corps public health center. i'll introduce the first panel after we receive the testimony

of the first -- the second panel. and just for senator tillis' benefit, i told him how wonderful you are at the opening of my remarks. [laughter] >> could you please repeat that? i'm sorry i'm running late. i went ahead and voted so we would not disrupt the hearing. senator gillibrand, thank you for your advocacy, the work that i'm well aware of that we need to continue to work on. i've worked on this summit for a long time when i first came to the senate. i was involved with trying to get the presumptions in place for toxic fortunately after a lot of tech and forthwith the va we were successful. we have more work to do. by masking the veterans affairs committee has unanimously her order that the till and we will continue to work on the va committee to do right by those who were exposed. the objective at today's hearing

in its something i've said on a number of fronts whether it's traumatic brain injury low-level concussion and things that men and women on the duty experience and problems in the long-term credit think we have an opportunity to get ahead of it. instead of waiting for the next agent orange what more can we do downrange and what more can we do in our military installations to understand the potential risk that we are putting our men and women potential in a position to where they too are going to have negative health consequences while they are serving or after they transitioned to veteran status. i look forward to talking with you all about how we can get ahead of the kerpen do a better job of tracking potential exposure so it makes it easy later on if we get into a

situation. we don't always know what what we'll be exposed to. once we know what we should make sure every health record of any manner with woman who was exposed to it as a dated and we can anticipate when they exhibit the first sentence -- symptoms. that's the end goal and i'm sure you agree there should be in end goal. i look forward to the testimony book forward to moving up in the cycle talking with t. pete to figure out what we can do to begin to bend the curve on some of the consequences that we have to deal with weatherman and women in uniform so thank you oi look forward to your testimony.

germ woman gillibrand ranking member tell us and members of the subcommittee thank you for inviting the department to testify before the senate armed services committeece hearing on military exposure of concern including airborne hazards. i'm pleased to represent the office of secretary of defense and have the opportunity to discuss the department's actions addressing airborne contaminants and open burn pits and military operations and the potential health tax to our servicemembers and veterans. joining me today in representing their militaryit departments are carnal -- colonel new wolf from the air force and captain feldman from the navy.. the department recognizes the concerns about the potential health impact of their airborne exposures. the relationship between burn

pit exposure and illnesses have prompted active research by the department, the va the national academies of science engineering and medicine and other research institutions. the department and be a continued to support and fund these research efforts to better understand any health effects that will better inform the health care providers who are servicemembers and veterans. health care providers play a critical role in understanding health-related exposures and becoming proficient in assessing patient's exposure concerns. this month the department will launch in a dated version of the airborne hazards and open burn pit registry overview course for health care providers. in it -- and to the training

course and an airborne exposure exposure clinical toolbox is available to our health health care providers. the depart and of the va continues to share education training and outreach to improve exposure related clinical care. airborne hazards and those potential acute and chronic health effects during deployment and post-deployment. as such the department has enhanced its. and post deployment related health assessments and the separation of health investment to include more specific occupational and environmental exposure questions including questions on burn pits and other airborne hazards. the department and the pa are

currently collaborating in moldable efforts including the development of the worst ever individual longitudinaldi expose her. we call it i lar are fighting exposures summaries by leveraging personnel locations, environmental monitoring and health assessment data. the department is conduct in a comprehensive exposure monitoring capability assessment aimed at improving individual area exposure monitoring and recordkeeping across thehe installation, training and deploying environments. enforcing the department remains committed to continually improving our understanding of exposures of concern in a tensile health effects in order to prevent and mitigate exposures and clinically assess treat and care for

servicemembers and veterans. madam chairwoman that concludes my opening remarks and we stand ready to address your questions. >> thank you so much dr. rauch. are there innovative ways the department is working to do so? >> thank you for the question. i will start off so my colleagues can provide more detail. it primarily starts talking about the diploid infirmary that starts on site with preventive medicine teams that are collecting and bierman the data weathered the airborne data, soil data, water data and all of that data that's being collected

it does obviously include data that is generated from military operations to includede burn pis where there are. that data is collected by or preventive medicine units and it captured in a large database and specific called doors ix standing for -- and that database will become available to feed into the sub 19 which is the longitudinal looks does your record and in addition the iler will not only scrape the environmental health assessment data, it will also take data

from personnel locations so you can match the individual servicemember and this is in a location to the environmental health data that's being captured indoors and iler will present that data in what we call a joint longitudinal view were and summarize that data for a health care professional so he or she will be able to see where that servicemember was at any point in time and what they were exposed to. >> what is the time point that the data starts at what poignant time? >> urbanek medicine unit are part of the diploid force so they could be doing their

environmental health assessments on a weekly basis >> when did you start collecting this data? >> when i was on active duty in 1999ol we were collecting it in kosovo. >> you have it back to 1999 at least in you said there were our active burn pits today that you are monitoring.ri where does earn pits located? >> it's my understanding that their actur to burn its in the centcom area of operations. i can get with centcom and they can>> provide more detailed information. >> yes please are that interested the dod as a matter policy will no longer use burn pits to expose waye so that not the case we need to know that in second i would like to know all

the burn pits that military members are being exposed to today. >> i will get was so common provide that information. my dod directive we will only use earn pits when it's a military operational assessment. everything else the way he or she manages that waste will not be f managed by an open burn pi. >> had they determined all burn pits for operational and necessary? have they determined the hundreds of burn pits that were used in the past were all operationally necessary? >> burn pits that were used in the past were used because when u.s. dabblers ofof a's camp and

the theater and each servicemember in the deployed forces generating 10 pounds or more of waste every day and they have 300 to 3000 that's a lot of daily waste and you have to manage it somehow and in amateur theater before you can install incinerators for contract to have it removed burn pits for use. >> understood in my final question which i think you answered. the process that is currently being used by dod and each of your services to determine if the servicemember has been exposed to toxic fumes during his deployment in how is the information recorded and who is given access to that

information? there are a number of ways. we have the redeployment assessment and a post-deployment assessment. that includes questions on airborne hazards, locations to exposure and in addition we have a separation assessment which also includes similar questions on health hazards and airborne contamination and location and that is, a separation assessment isnt tied to the va and in addition all of that is captured in databases captured under iler. >> you believe this data being captured goes back to 1999?

>> the war and monitoring that i was talking about the weed did in areas of kosovo were stationary air monitors. we didn't have the current systems and databases that we have today. we were writing them downn on paper back then. now it's all captured electronically. >> can you provide for the committee what years you have the environmental data for air quality in different deployments around thequ globe? >> sure. it goes back before 1990. >> that's excellent. so we can get that information. if we want to know air quality in k2 we could get air-quality fromqu k2?

>> if i came it air quality at k2 or should be able to. >> that's the kind of information we need because we know there were open burn pits from the testimony ofrs servicemembers and if we can get the location and make theirality for the dod to fully understand how to get that data. >> thank you chairman thank you for being here. you were saying in 1999 i'm sure that censors the change are medically. give me an idea now about the training for preventative medicine personnel about the nature of the censors and whether or not we are can do during that these are area sensors probably what is the state-of-the-art or in the dod

for wearable sensorshe so we can track them down in an individual situation. >> thank you senator. i will start that answer often i will defer to my colleagues and get detail from their perspective. we arete very interested in wearables. the reason is because our locus needs tol be on individual exposure monitoring. the thingsef i was talking about before the data that were capturing at the macro level -- you g will have 100 award 30 or more individuals and that data is very difficult to pinpoint exact we one individual is exposed. there's an old saying that says it all matters to the dose response and if we can figure out what the dose of the

exposure was in with their exposed to capture their response. i will defer to my colleagues on their preventive medicine units and the technology that they use. >> thank you senator. we are proud of our preventive medicine units. they are agile and they have a robust capability. for example they have sampling devices that are now part of the tri-service internet program. they support all services and have been diploid with the army mostly. that's a pretty conference of evaluation soil air and water, water vapor and that an individual portable level having a static sensor so that's the

robust capability and it's really cutting-edge. with regard to wearables we have some very robust submarine atmosphericbu monitoring quite a robust program looking at silicon band wearables at the individual level exposure date on the sub dream. her research had biomarkers and other correlates that translate from models that will help us in the future it down to the level of exposure. >> colonel do you have anything to add to that?? >> for the department of the air force is very similar. we are into wearables. we have not instituted to get that they are in development. >> dr. peterson.

>> myself and mys, colleagues ae adjusted in wearable technology and it's important underscore preventive medicine detachments are skilled and equipped. certainly air-quality is not exclusive issue of concern as well environmental issues such as pest control management diseases and environmental engineer scientists and complementary clinical staff and public health and preventive medicine providing adjunctive and supportive support on sites not onlyly within the p.m. could ite but also providers downrange. it's a pretty synchronized in robust capability on the contingency of fortune to assess exposures and respond to them. >> one of the reasons we should focus on wearables is when we

have exposures hopefully part of the process that's being captured of the individual servicemembers and ultimately being transferred to the health record for the veteran for the implementation for the d.a. electronic health or did i think it's important to have a seamless transition and hopefully we get to a point where we are able to capture in a date so we can provide predictive analytics long before any symptoms have manifest. you have anything to add? >> i would add in addition to wearables we need to understand more about how the individual response to environmental exposures and what risk do they bring in background and lifestyle factors such as are you smoking a pack a day before

you are deployed? of their lifestyle vectors and whatat genetic background individuals bring. we need to understand those because they have an impact. >> thank you. senator holly. >> thank you senator tillis. you testified in your written testimony that since 2001 over 4 million now veterans as well as dod civilians in dod contractors deployed in theaters of operations. how many m of these were exposed to environmental the toxins including burn pits? do you know? >> i can imagine, all of them should than exposed to some type of airborne hazards if they were

deployed in various days camps. southwest asia just the military operation in the vehicles burn pits, everything else to include ofdstorms could create a lot potential for airborne hazards and if you were there you are exposed to it. >> what is dod's estimate for the number of individuals that would qualify her for the service related connection given how many individuals were exposed? >> i will have to take that for the i t record. i will get to as much detail as i can do vacant give you that off the top of my head c senato. >> that's fine. we will take it for the record could go was the practice of burn pits in other theaters during this period of time from

2001 forward, do you know? >> what other burn pits and combatant command? i will take it for the record. most of them should have been in the centcom aor though. >> okay. if they are in the centcom aor this is the same thing we were talking about roughly. tell me dod's collection of this data. we are dealing with servicemembers exposure to toxins and burn pit toxins and other airborne spread it seems like we have very limited data for a lot of this. why is bad? why a has the dod not collected this data for so long? >> i think we have improved the extent of the data and the

technologiesle that we collect e data within the continued to improve. we collect a lot of environmental health assessment data on a number of compounds and a number of airborne compounds in particular that matter and compounds that are in the motor pool over there and compounds in the soil that gives airless -- aerosolized as a result of the app ration. a lot of that is collected and that goes into the database to be called doors and doors is a large database that feeds into iler which is what i was talking about bush's individual longitudinalre exposure records and pinpoints the location. all of that of our mental data

and the health care provider can take a look and get kind of a summary of where the servicemember was what the environmental hazards were in that area and can best form of treatment regime for that servicemember. >> what about data available in the linkages between exposure that we have been b talking abot to airborne toxins including reticulated earned peck -- a burn pit and what is dod been doingha to collect the data analysis? >> it's a part of the data that we collect and store in our databases that linking those

exposures to illnesses has been somewhat challenging. a couple of years ago the national academy of sciences said there is consistent data from exposures in southwest asia to our deployed force him to illnesses such as persistent cough, asthma and a few other respiratory disorders. more data is needed and more specific data linking individuals to certain airborne hazards and their health outcomes is needed to be able to expand that. >> i will circuit back to you and the questions for the record as well.

thank you mr. chairman reid. >> a couple of follow-ups. senator gillibrand went to vote and she's probably waiting for the second vote to be called so i'm curious about when iler will be fully interoperable with dod is about tonic health record and the b.a. select chronic health record and what is the timeline? >> the timeline for full capability is 2023. but it is capable now. spare with the dod let tonic health workers against the va elect tronic health record would track with their ultimate told out. >> thatan is my understanding. >> tell me about dod research on taking the information that we have about potentially toxic exposures and making certain

presumptions about how that exposure could cause of bad outcome to a servicemember, so-called presumptions? >> with regard to human studies most of the human studies and human research that we sponsor and continued to sponsor really compares a group of employers to regroup a a control group of non-deployers to take a look at the location, environmental health assessment and what were the threats over their and then look at the differences in terms of the incidents of health outcomes between the deployed wars in that area and the control that were non-deployers. in addition to that we also have animal experiments at the air

force which are looking at kozier to animals of different airborne hazards to include compounds that you would see in burn pits versus airborne sand that you would see in that deployed environment and looking at the health effects and health outcomes in experimental animals. those are just a few. if my colleagues want to add anything please do. >> captain? >> thank you senator. i am aware of a lot of work by the navy medical research command and health research

center in san diego. they have been addition to collaborating with the va on the studies they have a millennium cohort which is a powerful source of an extremely large population allowing them to explore all these questions and i will defer to my colleagues on this. thank you. .. ted with open burn pits and other airborne toxic sin -- toxins, but it's difficult to find a direct link to those at this time. but there is many studies that are underway looking into that and, hopefully, in the future we'll be able to link that. i think the important thing with the ile e r is it captures the cay that, it e las vegas links it to the individual. it also captures data when the individual rereturns from deployment and asks them if they have any concerns with airborne

hazards or if they answer to the affirmative, there's always a provider thate, will address tht with them if they also have post- deployment assessment that occurs 90 to 100 days after they get back it's the same question. they ask if they have symptoms for concerns with chemicals and once again if they are answered in the affirmative and the provider get with them and they talk to them. during preventative health assessment, that goes into those questions again, it something every member of the department of air force gives annually, they askeded the same questions and go into the open burn pit registry and encourage all members to register for that. ce. they're encouraged to go ahead and register for that. and once again, a provider will reach back, talk with them and go over any questions or concerns they might have.

>> dr. mirza? >> thank you, senator. in our organization at the army public health center we've engaged in several epidemiological studies, and in those the studies we essentially use deployment history as a proxy for exposures. and so, of course, that can include exposures to burn pits but also to the poor aeroquality conditions within -- air quality conditions within the area of operationings. and we also take that information and look at the health status of those individuals before they deployeded and after they deployed to make determinations about whether or not associations existed for particular respiratory disorders of interest. what we have found is that these epidemiological studies are not always very conclusive, and a lot of that has to do with limitations obviously study because we don't necessarily have individualized exposure information tied to individuals and their health outcomes. that's a significant limitation. but what we do have the strongest evidence to suggest is

that respiratory systems are present in many deployers into the centcom area of operations as a function of the air quality issues that are there. so symptom are shortness of breath, cough, fellow productio, detriments in their ability to successfully pass their physical performance tests and things of that nature. so we have that information. other studies have been conducted by looking at deployers themselves and looking at them prospectively, how they have been managed clinically and what conditions they have suffered as a consequence of the deployment, particularly looking at respiratory conditions. a small study that was conducted looked at those particular deployers and determined about half of those individuals didn't have necessarily diagnose if bl conditions per se despite the fact that they had symptom that they complained about, but the other half seemed to have symptom consistent with asthma

and hyperreacttivity of the air way and such. the bottom line is there's been a lot of studying occurring about deployers and their respiratory the health and the potential associations that exist if with a deployment. with but based on limitations on expose to your data, it is very difficult to make strong conclusions about the source of exposure and those health outcomes. >> thank you. >> the department's prepared statement for this hearing states that peer-reviewed published research documents that military personnel deployed to iraq and afghanistan appeared to experience upper respiratory symptom during deployment and may be at greater risk for respiratory illnesses. dr. mirza, please describe what your service does to insure that service members concerned about potential health effects of exposure to airborne hazards

receive appropriate health care, and is this documented in their health records, and will this information be available to the v.a. when it was the service member leaves service and receives care through the v.a.? >> senator, thank you for that question. i'll walk you through, essentially, a process that we undertake. first, when individuals are in a deployed environment and they are suffering with any respiratory ill illness -- rather, any illness or any symptom, we have medical personnel, we have medical centers that are deployed -- or mtfs that are deployed with appropriate personnel to respond to those concerns. those get documented and are available throughout the course of that service member's service treatment record to be looked at prospectively. when these individuals redeploy, they come back home, they undergo post-deployment health assessment, and there's essentially two parts. one is a screened questionnaire which individuals self-report concerns about their health, their respiratory symptoms and

other organ symptomology of interest, and we ask about their concerns of environmental exposures. a whole scope. not necessarily airborne, but chemical and so on. once they complete that self-assessment, these individuals then are evaluated by a provider, and they're given that option for a focused medical evaluation based on any concerns that they have advocated for on that self-assessment. routinely, we conduct periodic health assessments. this has a couple, a couple purposes. the first is to assure that individuals are assessed annually, that they maintain the medical standards and a certain level of physical fitness to be able to do their job. the second is to also identify any health outcomes or health issues of personal concern that need to be evaluated and managed further either by a primary care provider or a specialist that is going to be referred in for their care. but also as function of -- a

function, it's an additional opportunity to ascertain any concerns that person may have about exposures within the environment they operate or are deployed to. essentially, there are three main points of care, in my view, in which these individuals are evaluated is down range if they're experiencing symptom, it's when they return home as a function of the post-deployment health assessment process, and it's also at least annually on a periodic basis when they're going to -- through a periodic health assessment. >> [inaudible]

what they do to -- [inaudible] [inaudible] that information is captured -- [inaudible] when that information comes bac- [inaudible]

specific questions that are verbally reviewed to unsure -- [inaudible] those clinicians don't have the expertise -- [inaudible] environmental health -- to consult -- [inaudible] in addition to that, another layer of expertise -- [inaudible] >> thank you, senator. yeah, i agree with my colleagues. i'll just add on that iler does

record those specific questions that we ask about airborne hazards. we're not only looking at the occupational environmental health risk assessments of when the member was down range multiple times and reviewing those exposures, it's taking those little bit of questions that the member answered regarding hazards from the post-deployment assessment and the periodic health assessment. and we also have a few separation health assessment that's been under development for the last year, should be released this fall, and it also goes into detail about airborne hazards and chemicals of that nature. and that will also be documented. >> thank you. thank you for the question. any further questions? >> just one. i just want to echo senator gillibrand or reemphasize on current active burn pits. some of the process that a led