Select Committee on Defence Memoranda


Memorandum from the Ministry of Defence (26 April 2001)

CURRENT ACTIVITY RELATING TO GULF VETERANS' ILLNESSES

  1.  On 11 May 2000, the Defence Committee published[1] a memorandum submitted by the Ministry of Defence dated 8 December 1999 which described recent developments concerning Gulf veterans' illnesses. Further developments were covered in the Government's observations on the Seventh Report from the Defence Committee of Session 1999-2000, published on 3 August 2000. This memorandum updates the earlier material. As with the previous memorandum, the contents are set out under the five major headings that were used to categorise the Ministry of Defence's work to address veterans' health concerns in the policy statement "Gulf Veterans' Illnesses: A New Beginning", which was published in July 1997.

OPENNESS AND DIALOGUE

Meetings with veterans

  2.  When taking office in May 1997, the Government pledged that its dealings with Gulf veterans will be open and honest and that it will listen carefully to what they have to say. Ministers have held meetings with Gulf veterans' representatives, most recently in March 2001. Regular meetings have also been held between Gulf veterans' representatives and officials. All veterans' letters and telephone calls receive comprehensive replies. To assist veterans, the general enquiries helpline operated by the Gulf Veterans' Illnesses Unit (GVIU) and the helpline at the Gulf Veterans' Medical Assessment Programme (GVMAP) were made Freephone numbers in February 2000.

Newsletter

  3.  In December 2000, a 12-page newsletter titled Gulf Update was published by the Gulf Veterans' Illnesses Unit (GVIU). It included information on the GVMAP and the progress of research into Gulf veterans' illnesses as well as several other topics of interest to veterans. Around 400 copies have been sent to Parliamentarians, veterans, scientists and other interested parties. The newsletter is also on the Ministry of Defence website. Overall, the reaction to Gulf Update has been positive. It is planned that this newsletter will be published biannually.

Internet

  4.  In early 1998, a web page for Gulf veterans' illnesses issues was added to the Ministry of Defence website. It now has well over one hundred pages and is updated regularly, most recently being used to publish papers on depleted uranium. It has links to related websites including the US Department of Defense and, reflecting suggestions in the Defence Committee's Seventh Report that it should facilitate contact between veterans, to several veterans' charities.

International liaison

  5.  The US has approximately 697,000 Gulf veterans and the US authorities have a significant programme of work underway in respect of Gulf veterans' illnesses ($155M has been spent and 192 projects commissioned). Hence it is important for the UK Ministry of Defence to keep in close touch with developments there. The Ministry of Defence continues to have a full time Gulf Health Liaison Officer based in Washington DC, who is also the UK representative on the (US) Military Veterans Health Co-ordinating Board's (MVHCB) Research Working Group. (The MVHCB superseded the Persian Gulf Veterans Coordinating Board (PGVCB) in summer 2000). Both directly and through the liaison officer, the Ministry of Defence maintain close links with the US authorities, including the Executive Office of the President, the Department of Defense (including the Office of the Special Assistant for Gulf War Illness (OSAGWI), the Department of Health and Human Services, and the Department of Veterans' Affairs.

  6.  In April 2000, the US Office of the Special Assistant for Gulf War Illnesses visited the Ministry of Defence. Topics discussed included epidemiological research, historical research into various suggested chemical warfare agent exposures, the UK Fact Finding Team's report on the implementation of the immunisation programme, and the lessons identified from dealing with Gulf health issues.

  7.  Officials from the French Ministry of Defence visited GVIU in February 2001 to continue a dialogue about the two nations' respective Gulf health experiences. Earlier in February, members of the French National Assembly Information Commission investigating suggestions of Gulf illnesses in French veterans visited GVIU for presentations on Gulf health. Professor Lee, Head of the Gulf Veterans' Medical Assessment Programme (GVMAP), subsequently addressed the National Assembly in Paris in March 2001. The French Ministry of Defence has responded to suggestions that some of their veterans have illnesses linked to service in the Gulf by setting up an independent scientific and medical expert task group; by establishing a medical assessment programme; and by conducting some in-house studies and research.

MEDICAL HELP

GVMAP activity

  8.  The Ministry of Defence encourages any Gulf veteran who is concerned about his or her health to attend the Gulf Veterans' Medical Assessment Programme (GVMAP), located in the Baird Health Centre at St Thomas' Hospital, London.

  9.  The GVMAP has been running since 1993 and in that time has seen 3,133 patients. A further 57 are waiting to attend their first appointment. (All figures as at 23 April 2001.) There has been an increase in referrals since the beginning of 2001. For example in 2000 there were 162 referrals, but in January to March 2001 there were 78.

  10.  The GVMAP's service targets of sending out an appointment letter within five days of receiving a referral letter and of offering a patient an appointment within six weeks of the referral continue to be met.

Psychological and psychiatric assessment

  11.  In 1999, an arrangement was set up whereby individuals, who in the opinion of the MAP physicians would benefit from a psychiatric assessment, can be referred at the Ministry of Defence's expense to consultant psychiatrists with a specialist interest and expertise in post traumatic stress disorder (PTSD). A network of such consultants across the country has been set up. Treatment of ex-Service personnel is undertaken by the NHS in the usual way. If the patient is assessed as not suffering from stress reactions to trauma, but some other psychological problem, he/she can be referred on to an appropriate NHS specialist within his/her own area for further assessment and treatment. When these arrangements were reviewed in mid-2000 it became clear that some veterans were waiting too long for appointments and for the reports from these referrals. A fast-tracking arrangement was introduced and is currently meeting targets of appointments within six weeks of referral and a report within four weeks. GVMAP also decided to conduct a follow-up of the effectiveness of the treatments recommended in these cases. This will be done in conjunction with the referral network and aims to analyse the outcomes of treatment plans in 60-80 cases.

  12.  General standards for mental health care and treatment are set out in the mental health National Service Framework, published September 1999 by the Department of Health. In addition, guidance on War Pensioners (HSG (97) 31) has been issued. It states that the referral should make specific reference to the fact that the patient is a War Pensioner and requires treatment for the condition(s) for which he was awarded a pension; and that War Pensioners can use the NHS complaints system to resolve any alleged breakdowns in the arrangements for priority treatment (leading, ultimately, to the Ombudsman).

GVMAP audit

  13.  In late 1998, a management audit of the GVMAP was undertaken by the King's Fund Health Quality Service, looking at all aspects of patient care and the service provided by the Programme. The audit report was published on 26 April 1999 and a copy was placed in the Library of the House. In January 2000, GVIU published a report detailing the progress made by GVMAP in implementing the auditor's recommendations entitled "Response to the recommendations arising from the audit undertaken by the King's Fund Health Quality Service". An audit of investigations undertaken at the GVMAP has also been undertaken in conjunction with the Royal College of Pathologists and was completed in September 2000. The results were publicised in letters to Parliamentarians and veterans. The advice of the Royal College of Pathologists was that a number of tests should no longer form part of the routine package of investigations on those attending the GVMAP. This was because either the results had been effectively normal or the very small number of abnormal results resulted from clear-cut medical conditions diagnosed by other means. Nevertheless, it remains policy that the GVMAP physicians have the clinical freedom to arrange any tests that are indicated and that the tests no longer offered routinely will still be available if clinically indicated.

  14.  In response to the recommendations of the 1998 audit, GVMAP introduced a patient satisfaction questionnaire to garner feedback on performance. Up to 31 March 2001, this showed that from 275 patients responding, 95 per cent were satisfied and 26 per cent added comments to express the extent of their satisfaction. Feedback from satisfaction questionnaires has also enabled us to improve the service delivered. For example, we have made it clearer to veterans that the GVMAP consultants automatically write to their GPs at the time of the visit, and again approximately six weeks later, and that veterans have right of access to their GVMAP assessment report. We intend to be responsive to veterans' concerns. Recognising the difficulty that travelling to London causes some GVMAP patients, we have arranged to hold periodic Medical Assessments at Northallerton, North Yorkshire.

  15.  A paper entitled "Clinical findings of the Second 1000 UK Gulf War Veterans who attended the Ministry of Defence's Medical Assessment Programme" will be published in the June issue of the Journal of the Royal Army Medical Corps. A further paper entitled "Comparison of clinical findings in two consecutive cohorts and overall 2898 UK Gulf veterans who have attended the Ministry of Defence's Medical Assessment Programme 1993-2000" will be submitted for publication shortly.

Veterans and the NHS

  16.  In October 1998, the Ministry of Defence produced the first edition of an information pack, aimed at providing General Practitioners (GPs) and other health professionals with information which they may find useful in dealing with Gulf veterans' health concerns. On 31 January 2001 the pack was updated and sent in hard copy to all GPs in the UK as well as other interested health professionals (including the Defence Medical Services). The Chief Medical Officer (CMO) for Scotland wrote to doctors in Scotland about the revised pack on 31 January 2001 and doctors in England and Northern Ireland were notified of the revised pack in their respective CMOs' updates. The next CMO for Wales' update will be issued in May and will include a mention of the pack. These moves have led to a steady flow of requests for the pack from hospital consultants and other health professionals. Over 48,000 copies of the pack have now been sent out. The pack is available on the Gulf Veterans' Illnesses website. It is also available to health professionals on the NHS web, Scottish Health on the Web and the Health of Wales information service.

Gulf Veterans and Depleted Uranium

  17.  Our testing policy for uranium was initially set out in March 1999. All Gulf veterans are entitled to seek a referral to the Gulf Veterans' Medical Assessment Programme for a full medical assessment. Any tests that are considered clinically appropriate by the examining GVMAP physician, including those to detect the presence of uranium, will be arranged. Out of over 3,100 patients examined by GVMAP physicians, as of 2 April 2001, two had sufficient indications that, in the judgement of the examining physicians, provided a clinical requirement for testing to detect uranium. Their test results showed that uranium (in any form) was not a contributory factor to these patients' ill health.

  18.  In September 1999 we offered to test independently for depleted uranium those UK veterans whom we believe had their urine tested in Canada. Despite numerous requests, we have still yet to see scientifically robust results from this Canadian work, either sent to directly to us or in a peer-reviewed journal. The Ministry of Defence continues to hope such evidence will be forthcoming so that we can move forward on a scientific basis. A draft protocol under which the Ministry of Defence-sponsored independent testing might take place was sent to veterans' representatives on 1 November 1999 for comment. No agreement has been reached on the basis for this testing.

  19.  Media coverage at the beginning of 2001 caused concern amongst Service personnel and their families and we recognised a need to reassure them. Therefore, on 9 January 2001, the Minister for the Armed Forces, John Spellar, announced that the Ministry of Defence was taking urgent steps to put in place an additional appropriate voluntary screening programme for UK Service personnel and civilians who have served in the Balkans. It is intended that this screening programme should be equally applicable to Gulf veterans.

  20.  On 13 February 2001, the Ministry of Defence issued a First Consultation Document on proposals for this screening programme. A copy of the document is available on the Ministry of Defence's Internet website (http://www.mod.uk). This underlined our commitment to openness in developing proposals in line with the suggestions in paragraph 39 of the Defence Committee's Seventh Report. We fully intend to take the best scientific and medical advice and have received a total of 37 helpful and constructive responses to the Consultation Document. On 11 April 2001 we published a second consultation document. This includes four proposals. We propose the introduction of biological monitoring as part of a Health & Safety policy for current and future operations, where the risk assessment indicates a requirement. Secondly, tests for retrospective exposure assessment are to be developed and then used in an epidemiological study to answer the question "Does DU cause ill health"; the tests will also be available to any veterans that have particular concerns over DU exposure. Thirdly, we propose to await the outcome of the epidemiological study before deciding whether or not to recommend the test for retrospective exposure assessment for widespread use. Fourthly, we are proposing the establishment of an Oversight Board, comprising mainly external independent members, to enhance the confidence of Veterans and their representatives in the arrangements for the retrospective exposure assessment. Responses to the consultative document have been requested by 4 July.

RESEARCH

  21.  The results of research already available indicate that UK Gulf veterans report more illnesses than members of the Armed Forces who did not serve in the Gulf. However no evidence of a specific Gulf War Syndrome has been shown. The results of a considerable body of further research should be available for us to consider by the end of 2001.

Epidemiological studies

  22.  There have been three major epidemiological studies of UK veterans, of which two were funded by the Ministry of Defence and commissioned on its behalf by the Medical Research Council (MRC). A team at the University of Manchester has been investigating whether Gulf veterans suffer greater mortality and ill health than Service personnel who did not take part in the conflict. The results were published in The Lancet on 1 July 2000. The study found the number of deaths and the causes of death in the comparison group who did not deploy to the Gulf were similar to those recorded amongst Gulf veterans. The Ministry of Defence has identified 53,462 members of the UK Armed Forces who were deployed on Operation GRANBY or to a state in the Gulf region at some time between 1 September 1990 and 30 June 1991. As at 31 December 2000, 477 of these individuals were recorded by the Ministry of Defence as having died since 1 April 1991. This compares to 466 among a similar sized group of veterans randomly sampled from all those in service on 1 January 1991 who were not deployed to the Gulf. The causes of death for 468 of the Gulf cohort are known, and for 457 of the comparison group, and are shown at Annex A. The overall mortality rate ratio is 1.03. In other words there is a very small excess, which is not of statistical significance, of Gulf veterans deaths when compared to the comparison group.

  23.  For particular categories of cause, the data remain very similar to those published by the University of Manchester (which covered the period 1 April 1991 to 31 March 1999). There are less disease-related deaths among Gulf veterans than in the comparison group (168 and 208 respectively), but the numbers are too small for statistical analysis to determine whether this is significant or not. In particular, there were fewer deaths among Gulf veterans than the comparison group due to neoplasms (69 and 77 respectively) and due to diseases of the circulatory system (60 and 79 respectively).

  24.  In contrast, the number of deaths among Gulf veterans due to the external causes of injury and poisoning remains higher than among the comparison group (300 and 249 respectively) and is now statistically significant in total. The Ministry of Defence is investigating the road traffic accidents in further detail.

  25.  The ill health study has been presented in two papers: one dealing with the pattern and extent of reported ill health amongst Gulf veterans, and one with the relationship between health and exposures reported by Gulf veterans. These papers were published on 12 April 2001 in Occupational and Environmental Medicine. The first paper reinforces previous findings that although Gulf veterans report more severe illness than those who were not deployed to the Gulf, the overall severity of their symptoms is not high (3 on a scale of 1 to 21, as against 1.7 for non-deployed veterans). Indeed, the report found that "this lack of an excess in signs of morbidity is reassuring". As with earlier work, the research found no evidence of any illness unique to Gulf veterans - both groups report the same symptoms. The first paper concludes, "Such ill health has been reported after previous conflicts and it may be that this reflects changes in perception resulting from disruptions of war rather than specific chemical, physical, infective, or psychological exposures." The second paper suggests that vaccinations and the handling of pesticides might be a cause of certain patterns of ill health. However, the authors point out that "self-reported exposures may better reflect real events but are susceptible to bias in perception, recall or reporting may be influenced by personal characteristics of the individual."

  26.  The authors suggest the apparent link between vaccinations, pesticides and reported ill health is worthy of further study. They note, "It would be a disservice to these men and women who went to the Gulf and who collaborated with this research if the two central questions that arise from it were left unanswered. Do those who received many inoculations have objective markers of ill health that are different from those who did not? Do those who handled pesticides have peripheral nerve damage?" Such work is underway or planned (see below).

  27.  The second epidemiological study, at the London School of Hygiene and Tropical Medicine, is investigating the reproductive health of Gulf veterans, their partners and the health of their children. Data collection is now complete and the team are currently coding and analysing the data collected. It is expected that results will be published later this year.

  28.  The first two phases of the third, mainly US-funded, study carried out at Guy's, King's and St Thomas' School of Medicine are now complete. The results of Phase One of the study, which involved the completion of a health questionnaire, were published in The Lancet on 16 January 1999. The paper reported that UK Gulf veterans report symptoms of ill health up to three times more frequently than the other groups, although the symptoms do not appear to be unique to this group. A further paper published in the British Medical Journal on 19 May 2000 examined the link between multiple immunisations and ill health. The paper reported that multiple immunisations before deployment to the Gulf do not seem to be associated with ill health, whereas multiple immunisations given during the deployment do seem to be associated with ill health. It concluded that, "Multiple vaccinations in themselves do not seem to be harmful but combined with the `stress' of deployment they may be associated with adverse health outcomes." A paper published in the Journal of Epidemiology and Community Health in November 2000 reported that rank was the main occupational factor associated with ill health amongst Gulf veterans. A paper on Chronic Fatigue Sydrome (CFS) and Multiple Chemical Sensitivity (MCS) was published in the American Journal of Epidemiology in March 2001. The results showed a statistically significant higher level of MCS and CFS in Gulf veterans than in the control groups used. The actual numbers of personnel on whom the conclusions are based were however very small (135 cases of CFS and 57 cases of MCS out of a total of 8,195 study participants).

  29.  A paper by the team at Guy's, King's and St Thomas' School of Medicine entitled "Ten Years On; What Do We Know about Gulf War Syndrome?" was published in the Journal of the Royal College of Physicians to coincide with the tenth anniversary of the end of the Gulf conflict. The paper noted that "a syndrome implies a unique constellation of signs or symptoms" and that "the balance of evidence is against there being a distinct Gulf War Syndrome". It said that "no evidence has emerged to date of neither distinct biomedical abnormalities nor premature mortality". However it was noted that "Gulf service has affected the symptomatic health of large numbers of those who took part in the campaign". The team speculated that the most plausible causes were exposures that affected the majority of those in theatre, such as medical countermeasures or psychosocial factors.

  30.  Phase Two of the study at Guy's, King's and St Thomas' School of Medicine, which aimed to validate some of the findings of Phase One by conducting clinical examinations and medical tests on a randomly selected proportion of the study group is now complete. It is expected that the results will be published in 2001. A series of further papers arising from work under Phases One and Two of this work are also expected to be published in the scientific literature during 2001. These papers will include work on immunological function; psychiatric conditions; neuropsychological problems; illness perception; GVMAP attendees and Women in the Gulf.

Neuromuscular symptoms study

  31.  In a specific subset of this Phase Two work, funded by the Ministry of Defence, a team led by Drs Michael Rose and Mohammed Sheriff has investigated the hypothesis that symptoms of fatigue, weakness, muscle pain and sensory disturbance which have been reported by some Gulf veterans might be due to disturbance of the nerve or muscle function. It conducted tests on symptomatic Gulf veterans, who were identified through the existing King's epidemiological study, and suitable control groups. The study is expected to publish its findings in 2001.

King's Phase Three

  32.  The MRC has recommended a third phase of research by Guy's, King's and St Thomas' School of Medicine which will consist of a longitudinal study of the changing health of Gulf veterans over time, and a further analysis of the health of the Bosnia cohort examined in their earlier study. The Ministry of Defence is funding this research at a cost of about £150,000.

Interactions Research

  33.  The Ministry of Defence is funding research to look at the possible adverse health effects of the combination of vaccines and tablets which personnel were given to protect them against biological and chemical warfare agents. Work is being carried out partly by external bodies and partly at CBD Porton Down. An Independent Panel oversees the Interactions research programme.

  34.  The initial dose ranging study, using guinea pigs, was completed early in 1999 and the results were published on 21 January 2001 in the Journal of Applied Toxicology. The study investigated the health effects from administering the combination of vaccines and nerve agent treatments used during the Gulf conflict to guinea pigs. "Although immunological responses to bacterial vaccines were observed, there were no remarkable findings in the parameters measured". Current work at Porton Down is being conducted in a small primate, the marmoset, and aims to examine whether there are subtle long term cognitive or neurological changes as a result of the combination of vaccines and nerve agent treatment. The first two phases of this work established that the dose and panel of vaccines used in the guinea pig study were realistic for use in the marmoset. An outline of the findings were presented at the Conference on Illnesses among Gulf War Veterans: A decade of scientific research in Washington DC in January 2001. A retrospective study drawing upon health data from staff working at CBD Porton Down who have received multiple immunisations is now complete and the results will be submitted for publication soon. The programme as a whole is expected to be complete by 2003.

  35.  Work is currently being carried out at the National Institute for Biological Standards and Control to investigate the specific combination of anthrax and pertussis vaccines and pyridostigmine bromide using mice. This works attempts to replicate tests carried out in late 1990 which led the Department of Health to notify the Ministry of Defence that it had anxiety about the simultaneous use of the anthrax and pertussis vaccines. Initial toxicity tests are now complete.

Systematic literature review

  36.  In June 1998, the Ministry of Defence announced that it would be funding, through the MRC, a systematic literature review of worldwide published research relating to Gulf veterans' illnesses. It is expected that papers on Reproductive Health; Mortality; Psychiatric Disorders; Physical Diseases; and Unexplained Medical Symptoms will be submitted for publication during 2001.

Cost of Ministry of Defence research into aspects of Gulf veterans' illnesses

  37.  So far, approximately £4.7M has been spent on the Ministry of Defence-funded studies described above and it is estimated that they will cost a further £1.5M to complete.

Further research

  38.  In the light of the emerging research findings and the results expected later this year, the Ministry of Defence will be considering with the MRC, which acts as the Government's principal adviser on research strategy in this area, how best to take forward the Ministry of Defence—funded research programme, including the possibility of commissioning further studies. Researchers are welcome to submit proposals for additional research to the Ministry of Defence at any time. If the MRC suggest that a proposal would merit funding, then the Ministry of Defence would look favourably upon such a recommendation.

Organophosphate (OP) pesticides

  39.  Government research on OPs in relation to human health is currently co-ordinated through an inter-departmental liaison group. The Committee on the Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) published a report on OPs on 26 November 1999, which made a number of recommendations for further research. In order to address the questions posed by COT, and other questions raised by scientists working in the area, the Government has developed a targeted programme of research costing £1.4M, which was announced on 12 March 2001. The research aims to answer four questions:

       1.  How common is "dippers flu" and what causes it?

       2.  Does low-level exposure to OPs cause disabling neurological or psychiatric disease in a small sub group of exposed persons?

       3.  Other than acetylcholinesterese inhibition, what mechanisms play an important role in the causation of adverse health effects by OPs?

       4.  What are the effects of low-level exposure to OPs on Children?

The Ministry of Defence will continue to follow this research through its membership of the Interdepartmental Group on Organophosphates, chaired by MAFF.

  40.  The Ministry of Defence has also noted the work on levels of paraoxonase (an enzyme that metabolises organophosphates) in Gulf veterans undertaken by a team at Manchester Royal Infirmary and published in September 2000. The Ministry of Defence has facilitated arrangements for Manchester to contact the King's College team and the samples collected by King's during their Phase Two clinical studies are being tested at Manchester to see if the results can be replicated in a blinded study.

PROVISION OF INFORMATION

  41.  The Ministry of Defence will continue to publish material on Gulf veterans' illnesses related issues in fulfilment of the Government's declaration that veterans should have access to whatever information the Ministry of Defence possesses which might be relevant to their illnesses. The following papers have been published since publication of the Defence Committee's Seventh Report, or are planned:

Biological Warfare Alarms

  42.  On 18 May 2000, the Ministry of Defence published "A Review of the Activities of the 1 Field Laboratory Unit and Suggested Biological Warfare Agent Detections During Operation Granby". This paper examined the work of the 1 Field Laboratory Unit and investigated reported cases of biological warfare alarms being activated. As a result of a review of the available information, the paper assessed that UK troops were not subject to attack by or exposed to biological warfare agents during the Gulf conflict. There were alarms on some detectors, many of which were recognised to be false by the system operators at the time. On one occasion, a biological substance was detected and samples returned to the UK for testing. The tests concluded that this detection was not caused by a biological warfare agent. The paper re-examined this incident and concluded that the evidence suggests that the detection was caused by natural biological material.

Chemical Warfare Alarms

  43.  On 20 July 2000, the Ministry of Defence published "A Review of UK Forces Chemical Warfare Agent Alerts During the 1990/1991 Gulf Conflict". This paper looked at the general pattern of chemical alarms during the conflict. The review showed that there was usually a straightforward explanation given at the time for chemical warfare agent detection equipment alarming. There is no evidence to suggest Iraqi use of chemical weapons, or the presence of chemical weapons in any of the UK alarms.

Khamisiyah

  44.  On 7 December 1999, the Ministry of Defence published a paper entitled "Review of Events Concerning 32 Field Hospital and the Release of Nerve Agent Arising from US Demolition of Iraqi Munitions at the Khamisiyah Depot in March 1991". This paper reviewed the possible effects on UK units and in particular 32 Field Hospital of possible exposure to very low levels of nerve agent which may have been released as a result of US demolition activity at the Khamisiyah depot in Iraq. The Ministry of Defence is in the process of reviewing a second report published by the US Department of Defense in December 2000 on possible exposures to troops, which involved remodelling the earlier US work on the dispersal of the nerve agent. We will publish our conclusions in due course but our provisional view is that there is no reason to change the health assessment that we published in December 1999, that the possible level of exposure would have no detectable impact on human health, either in the short or long term. We assess that there is no evidence to link such a possible very low level of exposure to nerve agent released from Khamisiyah and the range of symptoms of ill health being experienced by some Gulf veterans.

FINANCIAL PROVISION

War Pensions

  45.  As at the end of February 2001, the War Pensions Agency (part of the Department of Social Security) held details of 4,385 Gulf veterans who have made a claim for a War Pension in respect of disablement arising from their service in the Armed Forces. Of these claimants, 3,781 have had their claims accepted and awards have been made and 216 claims have been rejected. The remaining 388 cases have either lapsed or are still under consideration. Of the total, 1,144 veterans have claimed for Gulf conflict related illnesses, of whom 975 have had their claims accepted and received awards. The remainder relate to those who have suffered a physical injury.

Attributable Benefits for Reservists Scheme (ABRS)

  46.  In addition to a War Pension, regular Service personnel who are medically discharged may also be eligible for attributable benefits linked to their degree of disability, as part of the Armed Forces Pension Scheme (AFPS) run by the Ministry of Defence. In 1980 it was decided to extend the AFPS arrangements to provide attributable benefits to certain categories of reservist personnel. This part of the AFPS is known as the Attributable Benefits for Reservists Scheme (ABRS). The intention was that provision for these categories of reservist personnel should be brought into line as closely as possible with that for regular personnel.

  47.  The Ministry of Defence practice is to pay benefits under the ABRS when a reservist has been medically discharged from a period of service in the volunteer reserve or immediately after the end of mobilised service. Following representations from ex-Service personnel, the Ministry of Defence began investigating whether awards should be made in other circumstances. On 18 May 2000, Minister of State for the Armed Forces, John Spellar, announced that the review into attributable benefits was complete. He explained that, under new regulations, volunteer and regular reservists who were part of a Reserve Force would be able to make claims if they were discharged from the reserve on medical grounds after demobilisation. Some reservists who were not formally members of a Reserve Force, such as ex-regulars with a long term reserve (LTR) commitment who were recalled for duty in the Gulf, would not, however, be eligible for benefits under the new regulations. The Minister explained that the Department would, therefore, examine sympathetically claims from such individuals, with a view to making ex-gratia payments where they would otherwise be treated differently from other Reserves, solely because of their status. We expect the new Reserve Forces (Attributable Benefits Etc) Regulations 2001 to be made by the end of April and payments will follow thereafter. The Gulf Veterans' Associations and other interested parties have been kept informed about the delay and the reasons why it has come about.

Legal claims for compensation

  48.  As at 1 April 2001, the Ministry of Defence had received 1,866 active notices of intention to claim from veterans and members of their families in respect of illness allegedly arising from the Gulf conflict. However, no writs or claims of sufficient detail have yet been received.

Additional financial assistance

  49.  The Government is not persuaded that, on the basis of the information currently available to it, there is a case for paying additional no fault compensation to Gulf veterans, separate from and above that which is already available to both Gulf and other veterans by way of war pensions and ABRS. However, the matter will be kept under review in the light of developments and ministers have made clear that if legal liability is established by future research or investigation, the Ministry of Defence will of course pay compensation.

Conclusion

  50.  The Ministry of Defence wants to understand why veterans of the Gulf conflict are now ill. This memoradum sets out the latest position on the wide range of work in different fields that the Ministry of Defence is currently undertaking in order to achieve that aim.


1   Defence Committee Session 1999-2000 Gulf Veterans' Illnesses Minutes of Evidence HC125 dated 19 April 2000. Back


 
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