HOUSE OF COMMONS SESSION 1999-2000 DEFENCE COMMITTEE Eleventh Special Report GULF VETERANS’ ILLNESSES Government Observations on the Seventh Report from the Defence Committee of Session 1999-2000 Rd, tr a ERTL Ordered by The House of Commons fo be printed 19 July 2000 PUBLISHED BY AUTHORITY OF THE HOUSE OF COMMONS LONDON: THE STATIONERY OFFICE LIMITED £4-75 753 il ELEVENTH SPECIAL REPORT FROM THE DEFENCE COMMITTEE The Defence Committee The Defence Committee is appointed to examine on behalf of the House of Commons the expenditure, administration and policy of the Ministry of Defence (and any associated public bodies). Its constitution and powers are set out in House of Commons Standing Order No. 152. The Committee has a maximum of eleven members, of whom the quorum for any formal proceedings is three. The members of the Committee are appointed by the House and unless discharged remain on the Committee until the next dissolution of Parliament. The present membership of the Committee is as follows: Julian Brazier TD MP (Conservative, Canterbury) Jamie Cann MP (Labour, Ipswich)’ Harry Cohen MP (Labour, Leyton and Wanstead)’ Mike Gapes MP (Labour/Co-op, Ilford South)’ Bruce George MP (Labour, Walsall South)’ Mike Hancock MP (Liberal Democrat, Portsmouth South)‘ Stephen Hepburn MP (Labour, Jarrow)? Jimmy Hood MP (Labour, Clydesdale)’ Dr Julian Lewis MP (Conservative, New Forest East)° Laura Moffatt MP (Labour, Crawley)’ Peter Viggers MP (Conservative, Gosport)’ On 16 July 1997, the Committee elected Mr Bruce George as its Chairman. The Committee has the power to require the submission of written evidence and documents, to examine witnesses, and to make Reports to the House. In the footnotes to this Report, references to oral evidence are indicated by ‘Q’ followed by the question number, references to the written evidence are indicated by ‘Ev’ followed by a page number. The Committee may meet at any time (except when Parliament is prorogued or dissolved) and at any place within the United Kingdom. The Committee may meet concurrently with other committees or sub-committees established under Standing Order No. 152 and with the House’s European Scrutiny Committee (or any of its sub-committees) for the purpose of deliberating, taking evidence or considering draft reports. The Committee may exchange documents and evidence with any of these committees, as well as with the House’s Public Accounts, Deregulation and Environmental Audit committees. The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the internet at www.parliament.uk/commons/selcom/defhome.htm. A list of Reports of the Committee in the present Parliament is at the end of this volume. All correspondence should be addressed to The Clerk of the Defence Committee, Committee Office, House of Commons, London SW1A OAA. The telephone number for general inquiries is 020 7219 5745; the Committee’s e-mail address is [email protected]. 'Rt Hon Menzies Campbell CBE QC MP (Liberal Democrat, Fife North East), was appointed on 14 July 1997 and discharged on 1 February 1999, John McWilliam MP (Labour, Blaydon) was appointed on 14 July 1997 and discharged on 24 November 1999, Dari Taylor MP (Labour, Stockton South) was appointed on 14 July 1997 and discharged on 8 December 1999, Michael Colvin MP (Conservative, Romsey) was appointed on 14 July 1997 and discharged on 3 Ai 2000, Crispin Blunt MP (Conservative, Reigate) was appointed on 14 July 1997 and discharged on 21 February Appointed on 14 July 1997 ‘pointed on 24 November 1999 , Appointed on 1 February 1999 N O,\ppOointed on 8 December 1999 W ey OE als in oe, Seay ee 20 1543363 Lt 6 9 1p SPECIAL REPORT The Defence Committee has agreed to the following Special Report:— GOVERNMENT OBSERVATIONS ON THE EIGHTH REPORT FROM THE COMMITTEE, SESSION 1999-2000 The Committee published its Seventh Report of Session 1999-2000, on Gulf Veterans’ II]Inesses (HC 125), on 11 May 2000. The government’s response to this report was received on 6 July 2000 and is published as Annex A to this Special Report. ANNEX A This memorandum constitutes the Government’s response to the House of Commons Defence Select Committee’s (HCDC) Seventh Report on Gulf Veterans’ Illnesses. This is the third occasion on which the Committee has reported on this issue and the Government welcomes their continued interest in this important subject. The report covers the period from July 1997 when the Government’s policy statement entitled “Gulf Veterans’ IIlnesses—A New Beginning” was published. That statement set out the way in which the Government would approach the subject of Gulf Veterans’ Illnesses. The Government undertook to deal with veterans in an open and honest manner, to engage in dialogue and to ensure that Gulf veterans would have prompt access to medical advice via the Medical Assessment Programme (MAP), to undertake appropriate research into Gulf veterans’ illnesses and to make all relevant information public. The Government believes that the observations made by the Committee are balanced and that they acknowledge the complexity of the central scientific issues. In particular the Government notes the Committee’s acknowledgement of the efforts that have been made over the past three years in addressing the concerns of Gulf veterans. Continuing to deal with these issues will remain a high priority for this Government. Annex B is an update to the MOD’s progress in implementing the 20 Key Points set out in “Gulf Veterans’ Illnesses—A New Beginning’. Detailed responses to the Committee’s specific comments and recommendations are as follows: MOD WEBSITE ON GULF VETERANS’ ILLNESSES We recommend that the MOD look at ways in which it could further enhance the information provided on its Gulf illnesses website, including facilitating contact between veterans. (Paragraph 15) The Gulf veterans’ illnesses website contains all the information and reports that have been published by the Gulf Veterans’ Illnesses Unit. It also contains information about MOD funded research, and the MOD’s Gulf Veterans Medical Assessment Programme. The website links to a wide variety of other related websites, including the War Pensions Agency, the MOD Veterans Advice Unit, the US Department of Defense Office of the Special Assistant for Gulf War Illnesses, the British Medical Journal, the Lancet and the United States Persian Gulf Veterans Co-ordinating Board—Research Working Group Annual Report to Congress. A link to the official Royal British Legion Website has recently been added. The Website has proved popular, scoring over 10,000 hits per month this year. . The website is being redeveloped as part of the general redevelopment of the MOD’s Internet presence. As part of the redevelopment the website address has been changed to http://www.gulfwar.mod.uk. Those using the old web address will be automatically re-directed to the new site. Veterans will henceforth be able to receive news and updates by e-mail subscription. _We will continue to add new information and to look at ways to enhance the website further for the future. iv ELEVENTH SPECIAL REPORT FROM THE MEDICAL ASSESSMENT PROGRAMME We believe that the MOD has been remiss in not using the data available to the MAP to better advantage. Research should have been instituted before now, based on the MAP's findings, to ascertain the prevalence of illness amongst all Gulf veterans and to determine whether the symptoms demonstrated by patients seen at the MAP are representative. This has been a wasted opportunity and has contributed to the low opinion which users of the MAP have of its services. (Paragraph 19) As MAP patients are self selected and thus not arandom sample of Gulf veterans, the prevalence - of illness amongst Gulf veterans as a whole cannot be determined from the MAP data. The prevalence of illness amongst Gulf veterans can onlyb e determined by epidemiological research, using random samples and comparing Gulf veterans with a similar group which did not deploy to the Gulf. This work is being undertaken separately at Kings College Medical School, Manchester University and the London School of Hygiene and Tropical Medicine. The primary purpose of the MAP is to undertake medical assessments of individual veterans. Nevertheless, the publication of MAP data has been a useful contribution to the debate on Gulf veterans’ illnesses. Data from the MAP has been used to produce a paper on the clinical findings from the first 1000 patients seen. A second paper covering the second 1000 patients has been submitted for peer- review publication. Work is in progress to produce two further papers looking at the third 1000 patients and an overview of all 3000 patients that have been to the MAP. MAP data is currently being used in a UK/US collaborative research project investigating “War Syndromes”. We were puzzled by the suggestion of a “low opinion which users of the MAP have of its services”. The user questionnaire introduced as a result of the external audit of the MAP showed that 92% of those who used the MAP and completed a questionnaire were satisfied with their assessment and 27% added further comments to express the extent of their satisfaction. Management Audit of MAP Although we welcome the progress made in implementing the management audit recommendations, it remains to be seen whether this will have a noticeable effect on the services veterans receive from the MAP. We look forward to seeing evidence that the improvements put in place are having a significant effect on the way the MAP operates. We also hope that the results of the clinical audit will be published in the very near future. (Paragraph 23) The Government is pleased to note the Committee’s recognition of the work done in implementing the MAP management audit recommendations. The Head of the MAP contacted the Royal College of Pathologists last year and at present we are awaiting final advice from the Royal College of Pathologists on the current range of routine investigational tests. The results of the review of the investigational tests undertaken at the MAP will be published as soon as possible and appropriate adjustments made to the range of tests routinely offered. Non-routine tests are available if considered appropriate by the MAP physicians and this will remain the case. Veterans’ view of MAP We believe it is important to centralise the expertise on Gulf illnesses in a single location and that London is the most appropriate location. We hope the MOD will consider providing additional assistance to Gulf veterans who have to travel long distances to the MAP. (Paragraph 25) We welcome the Committee’s conclusion that expertise on Gulf illnesses is best centralised in London. The MAP does all it can to make travelling to London as easy as possible—providing travel warrants and arranging and paying for accommodation near to the MAP and St Thomas’ Hospital for veterans and their carers if appropriate. Arrangements are in place for veterans who cannot travel to London to have medical assessments locally. Sometimes, where it is impossible for veterans to travel to London, MAP physicians have visited the patient; for example in prisons. In addition, we are now exploring the feasibility of holding medical assessment THE DEFENCE COMMITTEE Vv sessions outside London for Gulf veterans who cannot, or do not wish to, travel to London. PSYCHIATRIC ASSESSMENTS We hope that this audit has been carried out and look forward to seeing the results in the government’s response to this Report. (Paragraph 28) Since July 1999 the MAP has been utilising a network of psychiatric assessment centres with specialist knowledge of Post Traumatic Stress Disorder (PTSD) to which veterans have been referred as appropriate. In general we believe this system has been working very well. The MOD undertook to review progress made in this area once the system of referrals had been in place for one year. This has just been done in conjunction with the consultant psychiatrist who helped MAP to set up the PTSD network. Although the assessment of Gulf veterans for PTSD within this network has been very successful, it has become clear that, once diagnosed as suffering from PTSD, Gulf veterans are not always receiving the treatment they need. This is either because of a lack of local provision or a lack of knowledge on the part of their doctors as to what is available. We aim to reduce the time taken for patients to be seen and for reports to be written, and to ensure that patients are able to receive appropriate treatment through the NHS by providing more information to GPs about PTSD in general and the provision of treatment locally. We hope to implement some changes to our procedures shortly, which should result in speedier assessments and easier access to treatment. We will also pursue discussions with the Department of Health on the provision of treatment for PTSD. RECENT DEVELOPMENTS There have been serious inadequacies in the services MOD has provided to sick Gulf veterans, through the Medical Assessment Programme, over a number of years. It may now be time for the MOD thoroughly to review the way it provides medical assistance to Gulf veterans, taking full account of the views of veterans themselves, so as to provide a service which meets their needs and fulfils the MOD’s obligations to them. (Paragraph 29) We acknowledge that there have been past problems in the running of the MAP. However, more recently the MAP has been run efficiently and the vast majority of veterans have been well satisfied with its services. This is borne out by the external audit report published early in 1999 and the more recent responses to the satisfaction questionnaire. Nevertheless we consider carefully criticism of the MAP by any veterans. We continue to be responsive and will continue to improve the service delivered. For example, following feedback from satisfaction questionnaires we have made it clearer to veterans attending the MAP that MAP consultants automatically write to their GPs at the time of their visit and again approximately six weeks later and that veterans have a right of access to their MAP assessment report. If the Committee or veterans provide specific examples of where the MAP is failing to meet veterans’ needs we will consider each very carefully, and respond fully. We will also investigate any specific claims that serving Gulf veterans cannot get referrals to the MAP. ORGANOPHOSPHATES In its report the Committee noted that the MOD would continue to monitor the debate about organophosphate (OP) safety and review scientific evidence in the light of future research. (Paragraph 32) In order to address the questions posed by the Committee on Toxicity in its report of November 1999 and other questions raised by scientists working in the area, the Government is developing a targeted programme of research. This will look at the central issue that remains; whether low level exposure to OPs is a causative factor of the chronic symptoms reported by sheep farmers and others. vi ELEVENTH SPECIAL REPORT FROM PROGRESS IN ASCERTAINING THE CAUSES OF GULF VETERANS' ILLNESSES Depleted Uranium We hope that the MOD will learn from this and approach veterans’ concerns in a less defensive and more collaborative way. Whati s of immediate importance now is that Gulf veterans should be offered appropriate tests, based on the most up-to-date scientific information available. The full scope of the tests, and any limitations, should be clearly explained to those undergoing them. (Paragraph 39) Extensive data on the use of Depleted Uranium (DU) in the Gulf, its hazards and potential exposures was first published in 1993, and again in 1999. MOD remains open minded on the suggested link between DU and veterans’ illnesses and wishes to move forward in the light of scientific evidence. The MOD has met some of the scientists involved in DU testing for veterans to hear their views. We have urged the scientists who say they have tested British veterans as being “positive” for DU to publish and to share their data with us, but no response has yet been received. The MAP physicians will arrange for veterans to undergo any tests that they consider to be clinically appropriate. This includes testing for total urinary uranium if the examining physician assesses a Clinical need for it. A small number of veterans have undergone this testing. In addition to this, in September 1999 the MOD offered to test veterans who had their urine tested for DU in Canada and on whose behalf claims of high levels of DU in urine samples have been made. The MOD received little positive response initially to the proposed testing protocol that was sent to veterans for comment on 1 November 1999. However, MOD has recently held discussions with Gulf veterans’ representatives about protocols for testing. The MOD also wishes to ensure that appropriate scientific methods and ethical standards are used and has therefore proposed that both the MOD and veterans’ representatives independently nominate appropriate institutions that are able to carry out tests for Depleted Uranium (i.e. to determine the isotopic ratios of U235 and U238 in urine samples), in accordance with an agreed protocol. The MOD would also wish to ensure that veterans who accept the DU testing offer are clear about what is intended and that the results of any tests and the health consequences of the results are properly communicated to them. The use of depleted uranium is of wider relevance than Gulf veterans’ illnesses alone. The government have indicated that, where necessary, DU will continue to be used in ammunition, with the possible concomitant future implications for British personnel. (Paragraph 40) At present, no satisfactory alternative material to DU exists to achieve the level of penetration necessary to defeat Main Battle Tanks. The use of DU, therefore, remains an important potential option for the Armed Forces of this country. If the safety of British troops in any future operation were to require such a capability against Main Battle Tank armour, DU ammunition would be deployed and used. The radioactive and chemical toxicity hazards of DU are recognised, but we believe the risks to health which they pose are small. Nevertheless, we take appropriate precautions and detailed safety instructions on the hazards of DU are provided to all Service personnel during the course of pre-deployment training and to all units serving in operational theatres where there may be a risk of exposure. We hope that the MOD will take on board the findings of the Royal Society’s study of depleted uranium when they are available, even though it has not initiated the work. We expect the MOD to demonstrate that it is driving research in this area rather than, as has appeared to be the case so far, adopting a reactive approach and responding to new developments only when forced to by events. (Paragraph 40) The Government welcomes and actively supports the independent review of Depleted Uranium by the Royal Society Working Group. MOD presented evidence to the Working Group on 19 January. Arrangements are being made to provide the Working Group with a sample DU tank round to assist in their investigation. MOD has also made available relevant information it has THE DEFENCE COMMITTEE Vii received from international sources. In addition, a MOD Depleted Uranium Working Group has been established which aims both to provide a better explanation of the potential chemical and radiological hazards associated with DU, and to examine the potential for additional research. VACCINES—LESSONS LEARNED We conclude that it is now unlikely to be possible finally to prove or disprove, to the satisfaction of all parties, whether vaccines precipitated some of the illnesses presented by Gulf veterans. We are pleased that the MOD has acknowledged the deficiencies in its immunisation procedures during the Gulf Conflict and welcome the detailed research which has been undertaken to discover what went wrong and why. The MOD has demonstrated that lessons have been learned and improvements to procedures have subsequently been achieved. Unfortunately, this does not help those who may have suffered as a result of the initial deficiencies. (Paragraph 48) The Government welcomes the Committee’s acknowledgement of the information published by the MOD concerning vaccines. Since the publication of the Committee’s report, further independent work has been published by King’s College, London Gulf War Research Unit in the British Medical Journal (May 2000). This research was based on their initial hypothesis that multiple immunisations maybe associated with later self reported ill health in Gulf veterans, first put forward in the Lancet in January 1999. The researchers did not find an association between self reported ill health (reported by questionnaire) and the individual vaccines given in the 1990/91 Gulfimmunisation programme. Nor did they link self reported ill health to a particular combination of vaccines. Multiple immunisations before deployment to the Gulf do not seem to be associated with self reported ill health, whereas multiple immunisations given during the deployment do seem to be associated with self reported ill health. The paper suggests that this different outcome is stress mediated, but the paper does not suggest any mechanism which might explain this. The paper did not find an association between immunisations and traditional military stress (e.g. combat) or between immunisations and pesticide exposure. MOD is continuing with the programme of research at CBD Porton Down to investigate possible health effects of interactions between all the vaccines used in the Gulf conflict and pyridostigmine bromide, the Nerve Agent Pre-treatment. King’s College are undertaking further work on blood samples from UK Gulf veterans to investigate the hypothesis that veterans’ illnesses may be related to shifts in the balance of chemicals in the immune system, possibly due to stress. MEDICAL RECORDS We welcome the MOD’s acceptance that there were problems with medical record-keeping during the Gulf conflict, and the improvements which it has already put in place to improve such procedures. Recent experience has demonstrated that units may frequentlyb e deployed overseas. It is essential that full and up to date medical records are maintained for all individuals in the Armed Forces throughout their service careers and including any medical treatment received during deployments. (Paragraph 50) The Committee’s comments on Medical Record Keeping during deployments are endorsed. A new operational medical record (called an FM ed 965) has been introduced to overcome previous shortcomings in this area. MOD has introduced a post deployment screening procedure for troops returning from Sierra Leone, one aim of which is to ensure that all deployment medical data is recorded on an individual’s permanent medical record. We welcome the clarification of the MOD’s position on access to medical records, and trust that this will ensure that in future former and current Service personnel and their medical practitioners are able to obtain necessary information without undue delays. (Paragraph 52) We echo the Committee’s wish that Service personnel and their medical practitioners should be viii ELEVENTH SPECIAL REPORT FROM able to access the necessary information without undue delay but would re-iterate that for the reasons given in our evidence some delays are unavoidable. Chemical and Biological Attack It is regrettable that these studies took so long to get off the ground as the time lapse can only have had an adverse effect on the discoverable evidence. However, we are impressed with the level of detail contained in the studies, and the clarity with which they explain what occurred and the implications for UK personnel. (Paragraph 64) We welcome the Committee’s comments on the level of detail contained within these studies. Since the publication of the Committee’s report MOD has published a further paper entitled “A Review of the Activities of the 1 Field Laboratory Unit and Suggested Biological Warfare Agent Detections during Operation Granby”. A paper entitled “A Review of UK Forces Chemical Warfare Agent Alerts during the 1990/1991 Gulf Conflict” is due to be published shortly. The MOD has made good progress, therefore, in establishing what took place and addressing specific areas of concern which have been highlighted by veterans. The findings of this research are consistent with the view expressed to us in the United States, that it is likely that there is no single cause of Gulf veterans’ illnesses. If further progress is to be made in understanding the nature of Gulf veterans’ illnesses, detailed work will need to be carried out to ascertain whether there are any links between possible exposures veterans might have suffered and the symptoms which some are now exhibiting. (Paragraph 65) The MOD will continue to conduct research on exposures and on symptoms. Examples are the vaccines interactions work, work on NAPS and the immune system, the neuro-muscular symptoms study at King’s College, and the offer to test some veterans for Depleted Uranium. We will also monitor closely other ongoing work in the UK (e.g. King’s College clinical investigations, their immune systems research, and the Government funded research on organophosphates.) A substantial number of ongoing US projects are being closely monitored. ASSESSING THE EXTENT OF THE PROBLEM Epidemiological Studies — Future research But we believe that further research is necessary, and that it should be of the same high standard and detailed nature which has characterised the research into possible causes of veterans’ illnesses discussed above. (Paragraph 71) Werecommend that the government take advice, as a matter of urgency, from the Medical Research Council to enable systematic and detailed research to be conducted into the number of veterans with unexplained illnesses, the nature of the symptoms, and the way the illnesses are progressing. It is not sufficient for these studies to be based solely on questionnaires; a representative proportion of veterans should be seen by clinicians. Veterans and their associations should be asked for their views on the form the studies should take and their co-operation with them actively sought. The outcome of this research should enable us to have well-founded evidence of the morbidity and mortality amongst Gulf veterans to measure against comparable groups in the general population. (Paragraph 72) Research of the type suggested by the Committee is already underway or has been completed. The King’s College Phase 1 work published in the Lancet in January 1999 demonstrated the nature and frequency of symptoms in British veterans of the Gulf, Bosnia and those not deployed (who in epidemiological terms are the group against whom health should be measured). The MOD also commissioned the study being carried out by Professors Cherry and Macfarlane at Manchester University which is designed to ascertain the prevalence of illness. Work on this study is complete and the data is being analysed and the manuscript is being prepared for submission to a peer-reviewed scientific journal. Publication is out of the Government’s control as the research team has proper editorial independence. Another Manchester University study THE DEFENCE COMMITTEE ix completed by Professors Cherry and Macfarlane has looked specifically at the mortality of Gulf veterans in relation to a comparable group of Servicemen. Their results were published in the Lancet on 1 July 2000. This study showed no statistically significant excess of deaths among UK Gulf veterans. The MOD plan to update Gulf veteran and control group mortality data on a regular basis. Similar work is planned on the incidence of cancer in Gulf veterans. In Phase 2 of their study, the team at King’s College has been conducting clinical examinations of 400 Gulf and other veterans who took part in the questionnaire based Phase 1 of the study. Ill Gulf veterans and three control groups of ‘well Gulf? ‘sick Bosnia’ and ‘sick era’ have undergone two days of intensive clinical testing. The Government remains open to the possibilities of further research. The MOD has stated that researchers may, at any time, put their proposals to the Medical Research Council (MRC) for peer review and that MOD will consider any proposal that has been formally reviewed and approved by the MRC. However, a general principle has been that research into specific causes of Gulf veterans’ illnesses should await the outcome of the epidemiological studies currently underway which will define the nature and extent of any unusual ill health in the population which deployed to the Gulf. In this context, the King’s College proposals for Phase 3 of their study have recently been approved by the MRC. Phase 3 will involve a longitudinal follow up study of UK Gulf veterans, to determine whether their overall health has improved or not. They will also further analyse their existing data concerning the health of the group of Bosnia peacekeepers that were originally used as a control group for the Gulf group. MOD will fund this new work, at an estimated cost of £150K. , The Government has also sought advice from the MRC on current research into Gulf veterans’ illnesses, and guidance about the appropriate future direction of research based on what has been achieved to date. The MRC will continue to give advice to the MOD on potential research proposals. We suggest that the new Chief Scientific Adviser be encouraged to review the past scientific advice given to the Ministry on Gulf War illnesses and to draw lessons from this for the future. (Paragraph 73) The Government accepts that the lessons of the Gulf conflict need to be learnt and that the resources and mechanisms required for future health surveillance of veterans needs to be examined. The MOD is currently compiling a ‘Lessons Identified’ paper that draws together various strands of the lessons of the Gulf with a view to ensuring that they are incorporated in future operational and deployment health policy. We will cover the provision of scientific advice on Gulf veterans’ illnesses. FINANCIAL ASSISTANCE War Pensions Despite all the detailed research discussed above and the genuine efforts being made by the MOD to put more information into the public domain, it is possible we may never find the answer to the causes of Gulf veterans’ illnesses. What is important, though, is that those who have served their country feel that they are adequately compensated if they have suffered illness as a result of their service. (Paragraph 74) The Government welcomes the Committee’s comments on the efforts made to put information regarding Gulf veterans’ illnesses into the public domain. We accept that those who have served their country should be adequately compensated for ill health arising from their Service. This is currently provided by War Pensions, the Armed Forces Pension Scheme attributable benefits and preferential rates of pensions and supplementary allowances compared with most Social Security equivalents. x ELEVENTH SPECIAL REPORT FROM However, we believe there is a case for waiving the seven-year rule in relation to Gulf veterans because the nature of their illnesses means that it may be some years before symptoms, and their severity, are apparent. This waiver could be extended to other groups if their circumstances were comparable. The MOD should not use its overall review of pensions as a means of deferring action to assist Gulf veterans, and we look forward to an early announcement of the government's position. (Paragraph 77) The Government believes that the legislation covering claims made outside the seven year rule is sufficiently generous to allow claims for war pensions to succeed. For deaths arising, or disablement claims lodged within seven years of termination of service, the onus lies with Secretary of State to show beyond reasonable doubt that the disablement or death is not due to service. There is no onus on the claimant to show any link between disablement and service. These provisions are in Article 4 of the Naval, Military and Air Forces (Disablement and Death) Service Pensions Order 1983, as amended. Even where a claim for disablement is made more than seven years after termination of service, or where death occurs more than seven years after service, the onus of proof is still more generous than the burden of proof in civil tort which rests ona balance of probabilities. Article 5 of the Naval, Military and Air Forces (Disablement and Death Service Pensions Order 1983, as amended provides that it is necessary for the claimant only to raise reasonable doubt, based on reliable evidence, that the death or disablement is due to service. The benefit of any reasonable doubt is always given to the claimant. As these provisions have applied to claims for war pensions for half a century it would not be feasible to restrict any concession on the seven year rule to Gulf veterans. Whilst it is true that the rule switches the onus from the Secretary of State to the claimant at the seven year point, for a claim to succeed it requires only that the claimant produces reliable evidence to raise a reasonable doubt. Therefore, were further research to show any reliable evidence of there being a service-related cause for an otherwise unexplained illness, claims for war pension could succeed. This applies not only to Gulf conflict related claims, but to any medical condition suffered by any participant in any theatre. The seven year rule applies not from the end of any given conflict but from the point the individual ends their total service. Some Gulf veterans could still be benefiting from its provisions for over 20 years to come. We welcome the improvements which appear to have been made in the way the War Pensions Agency deals with Gulf veterans and, in the light of the recommendations made by the Social Security Committee last Session, we hope to see further evidence that effective claims and appeal procedures are in place. (Paragraph 81) The Government is pleased that the Committee has recognised the positive steps taken by the War Pensions Agency (WPA) to improve the handling of Gulf claims. The WPA has further streamlined some of its processes in relation to Gulf claims, and efforts to reduce the time it takes to deal with these cases and to improve communications with Gulf veterans, continue. MOD and the WPA have also improved their co-ordination on Gulf veterans’ matters. ABRS The Committee notes in its report that there has been no outcome from the review of ABRS (Attributable Benefit for Reservists Scheme). (Paragraph 82) The Minister of State for the Armed Forces announced on 18 May 2000 an extension of the benefits available to members. of the Reserve Forces who served in the Gulf. This announcement was the result of the completion of a review into attributable benefits, which began in the summer of 1998. It has taken some time to complete the review as the rules and regulations applying attributable benefits for Reservists are complex and required MOD to seek advice from its legal adviser and Counsel about the scope of the regulations. Up until now some Reservists have been denied attributable benefits from the Armed Forces Pension Scheme because MOD has awarded benefits only if an individual was medically discharged when he was demobilised from active service. Following the review MOD will now consider claims from Reservists who were medically discharged from the Reserve Forces at other times. MOD is reviewing a number of existing claims from Reservists, and will also consider new claims from Reservists who did not submit at the time of their discharge from the Reserve because of the way